Individual
JEAN A WIEDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2516 STOCKTON BLVD, SACRAMENTO, CA 95817-2208
(916) 734-3557
(916) 734-7890
Mailing address
419 HERON PL, DAVIS, CA 95616-7512
(530) 759-0726
Taxonomy
Speciality
Code
Description
License number
State
2080P0208X
Pediatric Infectious Diseases Physician
Primary
C043137
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C0431370
MEDICAL#
CA
Enumeration date
11/21/2005
Last updated
11/29/2011
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