Individual
DR. MARK WELLISCH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
16311 VENTURA BLVD, SUITE 800, ENCINO, CA 91436-2124
(818) 788-7343
(818) 788-9453
Mailing address
16311 VENTURA BLVD, SUITE 800, ENCINO, CA 91436-2124
(818) 788-7343
(818) 788-9453
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
A23373
CA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
A23373
CA
2080S0010X
Pediatric Sports Medicine Physician
A23373
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A233730
—
CA
Enumeration date
11/07/2005
Last updated
09/11/2025
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