Healthcare Provider Details

I. General information

NPI: 1003157942
Provider Name (Legal Business Name): THOMAS WOHLSTADTER DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6815 NOBLE AVE
VAN NUYS CA
91405-3796
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-6690
  • Fax: 818-901-6699
Mailing address:
  • Phone: 714-347-1010
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A5559
License Number StateCA

VIII. Authorized Official

Name: DR. THOMAS C WOHLSTADTER
Title or Position: PRESIDENT
Credential: DO
Phone: 714-347-1010