Healthcare Provider Details

I. General information

NPI: 1528297009
Provider Name (Legal Business Name): WLED WAZNI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 LINDEN AVE FL 2
LONG BEACH CA
90813-3321
US

IV. Provider business mailing address

478 S OAKLAND AVE UNIT 3
PASADENA CA
91101-4032
US

V. Phone/Fax

Practice location:
  • Phone: 562-491-9270
  • Fax: 562-491-7985
Mailing address:
  • Phone: 586-303-5519
  • Fax: 626-566-2866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number60928 - 20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberA147166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: