NPI |
1205450889 |
|
Entity Type Code |
1 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider Last Name Legal Name |
WETZLER |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider First Name |
MARIE |
The first name of the provider, if the provider
is an individual. |
Provider Middle Name |
CASTANEDA |
The middle name of the provider, if the provider
is an individual. |
Provider First Line Business Practice Location Address |
5767 MISSION ST |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address City Name |
SAN FRANCISCO |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address State Name |
CA |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Postal Code |
941124208 |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
4155843294 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
5/30/2020 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
5/30/2020 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
225200000X |
The code designating the provider’s gender if the provider is a person. |
Provider License Number 1 |
8842 |
|
Provider License Number State Code 1 |
CA |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
Y |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
NPI Certification Date |
5/30/2020 |
|