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General NPI Number Information
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NPI Number | 1982875704
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Entity Type | Organization
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Legal Business Name | CARL WOLNISTY MD INC
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Dates
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Enumeration Date | 03/19/2008
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 3838 SHERMAN DR SUITE 7
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City | RIVERSIDE
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State | CA
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Zip | 92503-4098
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Country | US
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Telephone | 951-688-5122
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Fax | 951-688-8145
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Provider Business Mailing Address
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Address Line | 3838 SHERMAN DR SUITE 7
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City | RIVERSIDE
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State | CA
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Zip | 92503-4098
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Country | US
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Telephone | 951-688-5122
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Fax | 951-688-8145
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARL WOLNISTY
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Credential | M.D
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Telephone | 951-688-5122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G5804
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License Number State | CA
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