Organization
CARL WOLNISTY MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL WOLNISTY M.D (PRESIDENT)
(951) 688-5122
Entity
Organization
Contact information
Practice address
3838 SHERMAN DR, SUITE 7, RIVERSIDE, CA 92503-4098
(951) 688-5122
(951) 688-8145
Mailing address
3838 SHERMAN DR, SUITE 7, RIVERSIDE, CA 92503-4098
(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
—
CR239A
MEDICARE PTAN
CA
Enumeration date
03/19/2008
Last updated
10/05/2011
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