Healthcare Provider Details

I. General information

NPI: 1124039029
Provider Name (Legal Business Name): WENNEKER & LOFTUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 VILLA LANE SUITE 3
NAPA CA
94558-6417
US

IV. Provider business mailing address

3443 VILLA LANE SUITE 5
NAPA CA
94558-6417
US

V. Phone/Fax

Practice location:
  • Phone: 707-226-2034
  • Fax: 707-252-1087
Mailing address:
  • Phone: 707-226-2034
  • Fax: 707-252-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberC529280
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. SASHA J RIOS
Title or Position: OFFICE MANAGER
Credential:
Phone: 707-226-2031