Individual
RICHARD WASLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
31872 SOUTH COAST HIGHWAY, RADIOLOGY DEPARTMENT, LAGUNA BEACH, CA 92651
(949) 499-7195
Mailing address
DEPT LA 21650, PASADENA, CA 91185-1650
(949) 263-8620
(949) 263-1639
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G78097
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G780970
BLUE SHIELD
CA
Enumeration date
05/17/2006
Last updated
08/29/2024
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