Healthcare Provider Details

I. General information

NPI: 1649370487
Provider Name (Legal Business Name): CATHRYN JOHANNA WECHSLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E ROUTE 66
GLENDORA CA
91740-4670
US

IV. Provider business mailing address

437 W ADAMS PARK DR
COVINA CA
91723-1803
US

V. Phone/Fax

Practice location:
  • Phone: 626-335-4610
  • Fax:
Mailing address:
  • Phone: 626-332-7390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA23593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: