Individual
CRISTINA SUSANA WIESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
325 ROLLING OAKS DR, SUITE 100, THOUSAND OAKS, CA 91361-1201
(805) 557-0452
(805) 557-0471
Mailing address
5730 GREY ROCK RD, AGOURA HILLS, CA 91301-4442
(805) 557-0452
(805) 557-0471
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A91425
CA
207RG0100X
Gastroenterology Physician
Primary
A91425
CA
Other
Enumeration date
06/15/2006
Last updated
07/25/2012
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