Individual
DR. EDWARD J. WUCHNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15025 INNOVATION DRIVE, SAN DIEGO, CA 92128
(858) 592-1223
Mailing address
FILE# 54433, LOS ANGELES, CA 90074
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
C30331
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C303310
—
CA
01
—
013
CHAMPUS
—
01
—
B050
CHAMPUS
—
Enumeration date
10/04/2006
Last updated
06/30/2009
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