Healthcare Provider Details

I. General information

NPI: 1265621601
Provider Name (Legal Business Name): WILLIAM CHARLES WIRSHING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 MARENGO ST
LOS ANGELES CA
90033
US

IV. Provider business mailing address

1390 EL MIRADOR DR
PASADENA CA
91103-2724
US

V. Phone/Fax

Practice location:
  • Phone: 323-276-6400
  • Fax:
Mailing address:
  • Phone: 310-413-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberG50986
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG50986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: