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General NPI Number Information
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NPI Number | 1306156260
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Entity Type | Organization
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Legal Business Name | CRISTINA S. WIESE. M.D. INC.
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 07/25/2012
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Provider Practice Location Address
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Address Line | 325 E. ROLLING OAKS DR. SUITE 100
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City | THOUSAND OAKS
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State | CA
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Zip | 91361-1283
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Country | US
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Telephone | 805-557-0452
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Fax | 805-557-0471
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Provider Business Mailing Address
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Address Line | 325 E. ROLLING OAKS DR. SUITE 100
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City | THOUSAND OAKS
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State | CA
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Zip | 91361-1283
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Country | US
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Telephone | 805-557-0452
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Fax | 805-557-0471
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CRISTINA SUSANA WIESE
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Credential | M.D.
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Telephone | 805-557-0452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | A91425
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License Number State | CA
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