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General NPI Number Information
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NPI Number | 1750302022
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Entity Type | Organization
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Legal Business Name | JON S WILENSKY, MD, INC
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 05/28/2008
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Provider Practice Location Address
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Address Line | 4510 EXECUTIVE DR STE 105
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City | SAN DIEGO
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State | CA
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Zip | 92121-3022
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Country | US
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Telephone | 858-622-0200
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Fax | 858-622-0205
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Provider Business Mailing Address
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Address Line | 4510 EXECUTIVE DR STE 105
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City | SAN DIEGO
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State | CA
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Zip | 92121-3022
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Country | US
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Telephone | 858-622-0200
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Fax | 858-622-0205
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONATHAN S WILENSKY
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Credential | MD
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Telephone | 858-622-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A93345
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License Number State | CA
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