Provider Demographics
NPI:1962416339
Name:WITTE, WENDELL C (MD)
Entity type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:C
Last Name:WITTE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 3699
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-8699
Mailing Address - Country:US
Mailing Address - Phone:657-241-3600
Mailing Address - Fax:657-241-7708
Practice Address - Street 1:18785 BROOKHURST ST STE 200
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7300
Practice Address - Country:US
Practice Address - Phone:714-378-5330
Practice Address - Fax:714-378-5320
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2019-11-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC26304207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A33092Medicare UPIN