Healthcare Provider Details

I. General information

NPI: 1205964079
Provider Name (Legal Business Name): STANLEY H WISHNER MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 WILSHIRE BLVD SUITE 707
LOS ANGELES CA
90017-4810
US

IV. Provider business mailing address

1245 WILSHIRE BLVD SUITE 707
LOS ANGELES CA
90017-4810
US

V. Phone/Fax

Practice location:
  • Phone: 213-977-0101
  • Fax: 213-977-4993
Mailing address:
  • Phone: 213-977-0101
  • Fax: 213-977-4993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG22645
License Number StateCA

VIII. Authorized Official

Name: DR. STANLEY H WISHNER
Title or Position: OWNER
Credential: MD
Phone: 213-977-0101