Provider Demographics
NPI:1578634929
Name:WYTRZES, LYDIA MARIA (MD)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:MARIA
Last Name:WYTRZES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 SCRIPPS DR
Mailing Address - Street 2:SUITE 318
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6372
Mailing Address - Country:US
Mailing Address - Phone:916-564-3610
Mailing Address - Fax:916-564-3630
Practice Address - Street 1:87 SCRIPPS DR
Practice Address - Street 2:SUITE 318
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6372
Practice Address - Country:US
Practice Address - Phone:916-564-3610
Practice Address - Fax:916-564-3630
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG602132084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3562123Medicaid
CA3562123Medicaid
A53568Medicare UPIN