Healthcare Provider Details

I. General information

NPI: 1083640213
Provider Name (Legal Business Name): WAHIDULLAH WAHIDULLAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST JOSEPH HOSPITAL - EUREKA 2700 DOLBEER ST
EUREKA CA
95501-4799
US

IV. Provider business mailing address

1548 HILLSBOROUGH ST
CHULA VISTA CA
91913-2909
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-8121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA86761
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA86761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: