Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | G85851 | CA |
NPI | 1558441428 |
---|---|
Provider Name | Dr. Andrew Michael Wiesenthal |
First Address | San Francisco, CA 94105-0920 |
Second Address | San Francisco, CA 94105-0920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 23/01/2018 |