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Organization
SOUTHERN CALIFORNIA TRANSPLANTATION INSTITUTE
Active
Organization
SOUTHERN CALIFORNIA TRANSPLANTATION INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HAKAN ERIK WAHLSTROM M.D. (MEDICAL DIRECTOR/PRESIDENT)
(951) 275-9000
Entity
Organization
Contact information
Practice address
4000 14TH ST, SUITE 512, RIVERSIDE, CA 92501-4083
(951) 275-9000
(951) 275-5262
Mailing address
4000 14TH ST, SUITE 512, RIVERSIDE, CA 92501-4019
(951) 275-9000
(951) 275-5262
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A37140
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0078850
—
CA
Enumeration date
10/11/2005
Last updated
08/22/2020
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