MEDICARE: JON S WILENSKY, MD, INC

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	174400000X	Specialist	A93345	CA

General Provider Information

NPI Number	:	1750302022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JON S WILENSKY, MD, INC

Provider Business Mailing Address
First Line	:	4510 EXECUTIVE DR STE 105
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3022
Country	:	US
Telephone Number	:	858-622-0200
Fax Number	:	858-622-0205

Provider Business Practice Location Address
First Line	:	4510 EXECUTIVE DR STE 105
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3022
Country	:	US
Telephone Number	:	858-622-0200
Fax Number	:	858-622-0205

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JONATHAN S WILENSKY
Credential	:	MD
Telephone Number	:	858-622-0200

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	05/28/2008

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