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STEPHANIE S DITTMER MD

>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1942422688

Individual Registrant:
 STEPHANIE S DITTMER MD
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

Contact information for business:
670 9TH ST SUITE 203 ARCATA, CA 95521-6249 US
Tel: 707-826-8633  Fax: 707-826-8638

Registration Information:
NPI: 1942422688
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine
CAA117789

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
NATIONAL PROVIDER IDENIFICATION192422688CA01




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