Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 58504 | CA |
NPI | 1023338670 |
---|---|
Provider Name | Kirsten Rittenbach |
First Address | San Francisco, CA 94122-3748 |
Second Address | San Francisco, CA 94143-0440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2010 |
Last Update Date | 05/04/2013 |