| Cristina S. Wiese. M.d. Inc. | |
|
325 E. Rolling Oaks Dr. Suite 100 Thousand Oaks CA 91361-1283 | |
| (805) 557-0452 | |
| (805) 557-0471 |
| Full Name | Cristina S. Wiese. M.d. Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 325 E. Rolling Oaks Dr., Thousand Oaks, California |
| Authorized Official Name and Position | Cristina Susana Wiese (PRESIDENT) |
| Authorized Official Contact | 8055570452 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cristina S. Wiese. M.d. Inc. 325 E. Rolling Oaks Dr. Suite 100 Thousand Oaks CA 91361-1283 Ph: (805) 557-0452 | Cristina S. Wiese. M.d. Inc. 325 E. Rolling Oaks Dr. Suite 100 Thousand Oaks CA 91361-1283 Ph: (805) 557-0452 |
| NPI Number | 1306156260 |
|---|---|
| Provider Enumeration Date | 10/13/2010 |
| Last Update Date | 07/25/2012 |
| Medicare PECOS PAC ID | 2062605231 |
|---|---|
| Medicare Enrollment ID | O20101020000443 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306156260 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | A91425 (California) | Primary |
| Provider Name | Cristina S Wiese |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1710921564 PECOS PAC ID: 9830102110 Enrollment ID: I20060803000484 |
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