Healthcare Provider Details

I. General information

NPI: 1366487175
Provider Name (Legal Business Name): MARK D. WOLFSOHN, M.D., ANESTHESIOLOGY MEDICAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 MOBIL AVE
CAMARILLO CA
93010-6337
US

IV. Provider business mailing address

11999 SAN VICENTE BLVD STE. 440
LOS ANGELES CA
90049-5131
US

V. Phone/Fax

Practice location:
  • Phone: 805-484-8558
  • Fax: 805-484-3099
Mailing address:
  • Phone: 310-440-3131
  • Fax: 310-472-9582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG34454
License Number StateCA

VIII. Authorized Official

Name: DR. MARC D. WOLFSOHN
Title or Position: OWNER
Credential: M.D.
Phone: 310-440-3131