Individual
DR. SIDNEY EVAN WANETICK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19845 LAKE CHABOT RD, STE 302, CASTRO VALLEY, CA 94546-4055
(510) 886-3400
(510) 886-0861
Mailing address
7 BUTLER DR, LAFAYETTE, CA 94549-3358
(925) 283-9420
(925) 283-6518
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
G46693
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G46693
STATE MEDICAL LICENSE
CA
Enumeration date
05/31/2005
Last updated
07/08/2007
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