Healthcare Provider Details

I. General information

NPI: 1538301882
Provider Name (Legal Business Name): ERVIN S. WHEELER, M.D., A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8690 CENTER DR
LA MESA CA
91942-3057
US

IV. Provider business mailing address

8690 CENTER DR
LA MESA CA
91942-3057
US

V. Phone/Fax

Practice location:
  • Phone: 619-697-0227
  • Fax: 619-697-3970
Mailing address:
  • Phone: 619-697-0227
  • Fax: 619-697-3970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG20992
License Number StateCA

VIII. Authorized Official

Name: MRS. SWAN HOKSTAD
Title or Position: PATIENT COORDINATOR
Credential:
Phone: 619-697-0227