MEDICARE: DR. MARIUSZ WIRGA MD

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	2084P0800X	Psychiatry Physician	A74487	CA

General Provider Information

NPI Number	:	1346218625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIUSZ WIRGA MD

Provider Business Mailing Address
First Line	:	4201 LONG BEACH BLVD
Second Line	:	STE 203
City	:	LONG BEACH
State	:	CA
Zip	:	90807-2020
Country	:	US
Telephone Number	:	562-427-3897
Fax Number	:	562-309-9998

Provider Business Practice Location Address
First Line	:	4201 LONG BEACH BLVD
Second Line	:	STE 203
City	:	LONG BEACH
State	:	CA
Zip	:	90807-2020
Country	:	US
Telephone Number	:	562-427-3897
Fax Number	:	562-309-9998

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	02/28/2020

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