Healthcare Provider Details

I. General information

NPI: 1073120051
Provider Name (Legal Business Name): HUSSNA WAKILY MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 VISTA WAY STE 203
OCEANSIDE CA
92056-4559
US

IV. Provider business mailing address

3601 VISTA WAY STE 203
OCEANSIDE CA
92056-4559
US

V. Phone/Fax

Practice location:
  • Phone: 760-724-5352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HUSSNA WAKILY
Title or Position: SURGEON
Credential:
Phone: 760-724-5352