Provider Demographics
NPI:1992382394
Name:WETTERMANN CAPO, RENATA YVONNE (MD)
Entity type:Individual
Prefix:
First Name:RENATA
Middle Name:YVONNE
Last Name:WETTERMANN CAPO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RENATA
Other - Middle Name:YVONNE
Other - Last Name:WETTERMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1545 DIVISADERO ST STE 322
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-3400
Mailing Address - Country:US
Mailing Address - Phone:415-514-8686
Mailing Address - Fax:415-514-8666
Practice Address - Street 1:516 E NIZHONI BLVD
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5748
Practice Address - Country:US
Practice Address - Phone:505-722-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2025-0283208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics