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General NPI Number Information
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NPI Number | 1457496564
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Entity Type | Organization
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Legal Business Name | RONALD J WAHLIG, MD, INC
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2476 OVERLAND AVE SUITE 305
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City | LOS ANGELES
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State | CA
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Zip | 90064-3370
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Country | US
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Telephone | 310-559-8276
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Fax | 310-559-8284
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Provider Business Mailing Address
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Address Line | PO BOX 650
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-0650
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Country | US
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Telephone | 310-559-8276
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Fax | 310-559-8284
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Authorized Official
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Title or Position | OWNER
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Name | RONALD JOSEPH WAHLIG
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Credential | MD
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Telephone | 310-559-8276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G76939
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License Number State | CA
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