MEDICARE: JERZY WIERZBICKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	35358	CA

General Provider Information

NPI Number	:	1073059168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERZY WIERZBICKI

Provider Business Mailing Address
First Line	:	2117 GLENHOLLOW ST
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-2023
Country	:	US
Telephone Number	:	213-519-1548
Fax Number	:

Provider Business Practice Location Address
First Line	:	6040 PACIFIC BLVD
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-2931
Country	:	US
Telephone Number	:	323-583-5677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2017
Last Update Date	:	01/12/2017

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Directions to “ JERZY WIERZBICKI ” Practice Location

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