Individual
DR. JEROME ANTHONY WISNIEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2306 6TH AVE, SAN DIEGO, CA 92101-1643
(619) 232-0179
Mailing address
2705 28TH ST, SAN DIEGO, CA 92104-4902
(619) 232-0179
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E1630
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E16300
—
CA
Enumeration date
08/07/2006
Last updated
05/15/2024
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