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General NPI Number Information
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NPI Number | 1598794448
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Entity Type | Individual
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Provider Name | WOJCIECH GREGORY WIERZBOWSKI MD
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Gender | Male
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 03/26/2010
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Provider Practice Location Address
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Address Line | 600 COFFEE RD
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City | MODESTO
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State | CA
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Zip | 95355-4201
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Country | US
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Telephone | 209-524-1211
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 415
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City | SAN RAFAEL
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State | CA
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Zip | 94915-0415
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Country | US
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Telephone | 209-524-1211
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G49904
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License Number State | CA
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