Healthcare Provider Details

I. General information

NPI: 1386757094
Provider Name (Legal Business Name): THOMAS CRAIG WOHLSTADTER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12400 WILSHIRE BLVD STE 100
LOS ANGELES CA
90025-1067
US

IV. Provider business mailing address

2353 PROSSER AVE
LOS ANGELES CA
90064-2323
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-1646
  • Fax: 310-659-2333
Mailing address:
  • Phone: 310-650-3450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA05559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: