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NPI Code Detail

MEDICARE: DR. RICHARD L WULFSBERG M.D.

MEDICARE: DR. RICHARD L WULFSBERG M.D.
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
1174400000XSpecialistG20755CA
2207R00000XInternal Medicine PhysicianG20755CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G20755OTHERCAMEDICAL LICENSE

General Provider Information

NPI Number : 1821102922
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD L WULFSBERG M.D.
Provider Business Mailing Address
First Line : 16030 VENTURA BLVD
Second Line : SUITE 680
City : ENCINO
State : CA
Zip : 91436-2731
Country : US
Telephone Number : 818-990-1067
Fax Number : 818-981-1217
Provider Business Practice Location Address
First Line : 16030 VENTURA BLVD
Second Line : SUITE 680
City : ENCINO
State : CA
Zip : 91436-2731
Country : US
Telephone Number : 818-990-1067
Fax Number : 818-981-1217
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2006
Last Update Date : 12/04/2018

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