Healthcare Provider Details

I. General information

NPI: 1912014796
Provider Name (Legal Business Name): ROBERT D WIRTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23625 HOLMAN HWY
MONTEREY CA
93940-5902
US

IV. Provider business mailing address

P O BOX HH BUSINESS DEVELOPMENT & CONTRACTING
MONTEREY CA
93942
US

V. Phone/Fax

Practice location:
  • Phone: 831-624-5311
  • Fax: 831-625-4948
Mailing address:
  • Phone: 831-622-2716
  • Fax: 831-625-4764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberC32562
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberC32562
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberC32562
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberC32562
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC32562
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberC32562
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberC32562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: