Provider Demographics
NPI:1033228739
Name:WARMERDAM, DOROTHEEA OANA (MD)
Entity type:Individual
Prefix:DR
First Name:DOROTHEEA
Middle Name:OANA
Last Name:WARMERDAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3 PARK CENTER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-8341
Mailing Address - Country:US
Mailing Address - Phone:916-454-6191
Mailing Address - Fax:916-454-1015
Practice Address - Street 1:3 PARK CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-8340
Practice Address - Country:US
Practice Address - Phone:916-454-4861
Practice Address - Fax:916-454-3603
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96243207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0042242Medicaid
CAGR0042242Medicaid