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General NPI Number Information
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NPI Number | 1104267145
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Entity Type | Individual
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Provider Name | MARK GEOFFREY WAHRENBROCK M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/06/2013
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Last Update Date | 03/31/2021
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Provider Practice Location Address
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Address Line | 8901 ACTIVITY RD STE 205
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City | SAN DIEGO
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State | CA
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Zip | 92126-4436
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Country | US
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Telephone | 888-992-7555
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Fax |
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Provider Business Mailing Address
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Address Line | 8901 ACTIVITY RD STE 205
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City | SAN DIEGO
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State | CA
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Zip | 92126-4436
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZC0006X
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Taxonomy Name | Clinical Pathology Physician
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License Number | A158210
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License Number State | CA
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