MEDICARE: DR. DENNIS WAYNE EHRLICH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	G45623	CA

General Provider Information

NPI Number	:	1689788051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS WAYNE EHRLICH MD

Provider Business Mailing Address
First Line	:	8950 VILLA LA JOLLA DR STE C129
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-1707
Country	:	US
Telephone Number	:	858-450-5900
Fax Number	:	858-450-5903

Provider Business Practice Location Address
First Line	:	8950 VILLA LA JOLLA DR STE C129
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-1707
Country	:	US
Telephone Number	:	858-450-5900
Fax Number	:	858-450-5903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	03/07/2023

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