Healthcare Provider Details

I. General information

NPI: 1790600864
Provider Name (Legal Business Name): WAYNE WHITWAM MD INC A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 780
LA JOLLA CA
92037-1232
US

IV. Provider business mailing address

9850 GENESEE AVE STE 780
LA JOLLA CA
92037-1232
US

V. Phone/Fax

Practice location:
  • Phone: 858-824-2900
  • Fax: 858-824-2910
Mailing address:
  • Phone: 858-824-2900
  • Fax: 858-824-2910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: WAYNE B WHITWAM
Title or Position: PRESIDENT
Credential: MD
Phone: 858-824-2900