Healthcare Provider Details

I. General information

NPI: 1528004199
Provider Name (Legal Business Name): THOMAS M. WIGGINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WANKEL WAY
OXNARD CA
93031-6225
US

IV. Provider business mailing address

11999 SAN VICENTE BL. STE. 440
LOS ANGELES CA
90049-5042
US

V. Phone/Fax

Practice location:
  • Phone: 805-485-1908
  • Fax: 805-485-5767
Mailing address:
  • Phone: 310-440-3131
  • Fax: 310-472-9582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG18195
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: