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General NPI Number Information
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NPI Number | 1871471490
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Entity Type | Organization
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Legal Business Name | COLETTE WISEMAN, MD, INC
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Dates
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Enumeration Date | 08/22/2025
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 744 N KENTER AVE
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City | LOS ANGELES
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State | CA
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Zip | 90049-5105
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Country | US
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Telephone | 424-234-6461
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Fax |
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Provider Business Mailing Address
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Address Line | 11693 SAN VICENTE BLVD # 445
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City | LOS ANGELES
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State | CA
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Zip | 90049-5105
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Country | US
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Telephone | 424-234-6461
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. COLETTE WISEMAN
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Credential | MD
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Telephone | 424-234-6461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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