Healthcare Provider Details

I. General information

NPI: 1508956889
Provider Name (Legal Business Name): WENDELL HARRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 07/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD
SALINAS CA
93906-3100
US

IV. Provider business mailing address

PO BOX 2879
SALINAS CA
93902-2879
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4111
  • Fax:
Mailing address:
  • Phone: 831-755-6334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberA62779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: