Provider Demographics
NPI:1487460341
Name:VAN WIJK, XANDER MARIA ROBERTUS (PHD, DABCC, FADLM)
Entity type:Individual
Prefix:DR
First Name:XANDER
Middle Name:MARIA ROBERTUS
Last Name:VAN WIJK
Suffix:
Gender:M
Credentials:PHD, DABCC, FADLM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 BERRY ST STE 290
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1773
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:185 BERRY ST STE 290
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1773
Practice Address - Country:US
Practice Address - Phone:415-476-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTC-02003337207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine