Healthcare Provider Details

I. General information

NPI: 1336436369
Provider Name (Legal Business Name): GEORGE M WAHBA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 OLD RIVER RD
BAKERSFIELD CA
93311-9781
US

IV. Provider business mailing address

PO BOX 2323
BAKERSFIELD CA
93303-2323
US

V. Phone/Fax

Practice location:
  • Phone: 661-663-6550
  • Fax: 661-663-6259
Mailing address:
  • Phone: 661-324-0300
  • Fax: 661-324-4095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA97606
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA97606
License Number StateCA

VIII. Authorized Official

Name: DR. GEORGE M WAHBA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 661-324-0300