Individual
DR. JEFFREY WANNARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8554 LA MESA BLVD, LA MESA, CA 91942-9558
(619) 698-4471
Mailing address
6415 REFLECTION DR APT 206, SAN DIEGO, CA 92124-3167
(508) 898-0986
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2017-01040
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851728141
—
NC
01
—
19RFY
BCBS OF NC
NC
01
—
NCY8940322
MEDICARE
NC
Enumeration date
10/01/2013
Last updated
08/01/2020
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