Healthcare Provider Details

I. General information

NPI: 1467600288
Provider Name (Legal Business Name): DR. JEFFREY WIEZOREK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AMGEN CENTER DR MS 38-2-A
THOUSAND OAKS CA
91320-1730
US

IV. Provider business mailing address

1 AMGEN CENTER DR MS 38-2-A
THOUSAND OAKS CA
91320-1730
US

V. Phone/Fax

Practice location:
  • Phone: 805-447-5707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberA69564
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: