Healthcare Provider Details

I. General information

NPI: 1619956927
Provider Name (Legal Business Name): WARREN JASON WISNOFF DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 09/01/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7702 MEANY AVE SUITE 101
BAKERSFIELD CA
93308-5198
US

IV. Provider business mailing address

7702 MEANY AVE SUITE 101
BAKERSFIELD CA
93308-5198
US

V. Phone/Fax

Practice location:
  • Phone: 661-843-7830
  • Fax: 661-843-7831
Mailing address:
  • Phone: 661-843-7830
  • Fax: 661-843-7831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A9093
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number20A9093
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A9093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: