Healthcare Provider Details

I. General information

NPI: 1649349192
Provider Name (Legal Business Name): THERESA A WOEHRLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 SAN PABLO ST SUITE 1300
LOS ANGELES CA
90033-5310
US

IV. Provider business mailing address

1510 SAN PABLO ST 6TH FLOOR
LOS ANGELES CA
90033-5320
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-1313
  • Fax: 323-442-3051
Mailing address:
  • Phone: 323-442-4815
  • Fax: 323-442-3051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG46577
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberG46577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: