Individual
JOHN WIESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
13800 BIOLA AVE, LA MIRADA, CA 90639-0002
(562) 944-0351
(562) 906-4558
Mailing address
5499 TRAIL ST, NORCO, CA 92860-2477
(951) 738-1614
(562) 906-4558
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
01/20/2017
Last updated
01/20/2017
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