Individual
DR. CARL WOLNISTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3838 SHERMAN DR, SUITE 7, RIVERSIDE, CA 92503-4001
(951) 688-5122
(951) 688-8145
Mailing address
3838 SHERMAN DR, SUITE 7, RIVERSIDE, CA 92503-4001
(951) 688-5122
(951) 688-8145
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G5804
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CR238Z
MEDICARE ID PTAN
CA
Enumeration date
07/19/2005
Last updated
08/03/2010
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