# WENDELL MARK STREET, M.D., INC

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

## Provider details

- **NPI number:** 1902084783
- **Authorized official:** DR. WENELL MARK STREET M.D. (OWNER/MEDICAL DIRECTOR)
- **Authorized official phone:** (951) 640-1230

## Contact information

- **Practice address:** 11332 MOUNTAIN VIEW AVE, SUITE A, LOMA LINDA, CA 92354-3854
- **Practice address phone:** (951) 640-1230
- **Practice address fax:** (951) 924-2535
- **Mailing address:** 17868 US HIGHWAY 18, APPLE VALLEY, CA 92307-1267
- **Mailing address phone:** (951) 640-1230
- **Mailing address fax:** (951) 924-2535

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | A43837 | CA | Yes |

## Other

- **Enumeration date:** 02/04/2008
- **Last updated:** 02/04/2008