Organization
WENDELL MARK STREET, M.D., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WENELL MARK STREET M.D. (OWNER/MEDICAL DIRECTOR)
(951) 640-1230
Entity
Organization
Contact information
Practice address
11332 MOUNTAIN VIEW AVE, SUITE A, LOMA LINDA, CA 92354-3854
(951) 640-1230
(951) 924-2535
Mailing address
17868 US HIGHWAY 18, APPLE VALLEY, CA 92307-1267
(951) 640-1230
(951) 924-2535
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
A43837
CA
Other
Enumeration date
02/04/2008
Last updated
02/04/2008
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