| Carl Wolnisty Md Inc | |
|
3838 Sherman Dr Suite 7 Riverside CA 92503-4098 | |
| (951) 688-5122 | |
| (951) 688-8145 |
| Full Name | Carl Wolnisty Md Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3838 Sherman Dr, Riverside, California |
| Authorized Official Name and Position | Carl Wolnisty (PRESIDENT) |
| Authorized Official Contact | 9516885122 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carl Wolnisty Md Inc 3838 Sherman Dr Suite 7 Riverside CA 92503-4098 Ph: (951) 688-5122 | Carl Wolnisty Md Inc 3838 Sherman Dr Suite 7 Riverside CA 92503-4098 Ph: (951) 688-5122 |
| NPI Number | 1982875704 |
|---|---|
| Provider Enumeration Date | 03/19/2008 |
| Last Update Date | 10/05/2011 |
| Medicare PECOS PAC ID | 8123160447 |
|---|---|
| Medicare Enrollment ID | O20100126000170 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982875704 | NPI | - | NPPES |
| CR239A | Other | CA | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | G5804 (California) | Primary |
| Provider Name | Carl Wolnisty |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912906140 PECOS PAC ID: 3779625090 Enrollment ID: I20100126000161 |
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