Healthcare Provider Details

I. General information

NPI: 1316333842
Provider Name (Legal Business Name): WARREN J. WISNOFF, D.O., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7440 MEANY AVE SUITE B
BAKERSFIELD CA
93308-5183
US

IV. Provider business mailing address

7440 MEANY AVE SUITE B
BAKERSFIELD CA
93308-5183
US

V. Phone/Fax

Practice location:
  • Phone: 661-843-7843
  • Fax: 661-843-7834
Mailing address:
  • Phone: 661-843-7843
  • Fax: 661-843-7834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: NATALEE GARRETT
Title or Position: ADMINISTRATOR
Credential:
Phone: 661-331-1121