MEDICARE: DR. JONATHAN SETH WILENSKY 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	208200000X	Plastic Surgery Physician	A93345	CA
2	2086S0122X	Plastic and Reconstructive Surgery Physician	A93345	CA

General Provider Information

NPI Number	:	1871576470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN SETH WILENSKY MD

Provider Business Mailing Address
First Line	:	2867 VIA POSADA
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037
Country	:	US
Telephone Number	:	858-945-5720
Fax Number	:

Provider Business Practice Location Address
First Line	:	4510 EXECUTIVE DR
Second Line	:	SUITE 105
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3021
Country	:	US
Telephone Number	:	858-945-5720
Fax Number	:

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	08/12/2013

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