# WILLIAM M WANSA MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649579202
- **Authorized official:** WILLIAM M WANSA MD (PRESIDENT)
- **Authorized official phone:** (858) 352-6075

## Contact information

- **Practice address:** 250 PROSPECT PL, CORONADO, CA 92118-1943
- **Practice address phone:** (619) 522-3722
- **Mailing address:** PO BOX 28247, TEMPE, AZ 85285-8247
- **Mailing address phone:** (480) 967-6500
- **Mailing address fax:** (480) 967-6540

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | — | NULL | Yes |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/22/2011
- **Last updated:** 03/22/2011