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STEPHANIE S DITTMER MD
>> Family Medicine >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1942422688
Individual Registrant: STEPHANIE S DITTMER MD
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
3750 ROHNERVILLE ROAD FORTUNA, CA 95540 US
Tel: 707-725-6101 Fax: 707-725-2978
Tel: 707-725-6101 Fax: 707-725-2978
Contact information for business:
670 9TH ST SUITE 203 ARCATA, CA 95521-6249 US
Tel: 707-826-8633 Fax: 707-826-8638
Tel: 707-826-8633 Fax: 707-826-8638
Registration Information:
NPI: 1942422688
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 207Q00000X | Allopathic & Osteopathic Physicians Family Medicine | CA | A117789 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| NATIONAL PROVIDER IDENIFICATION | 192422688 | CA | 01 |
