1578851879 NPI number — DAVID MORGAN WANGLER CRNA

Table of content: DAVID MORGAN WANGLER CRNA (NPI 1578851879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578851879 NPI number — DAVID MORGAN WANGLER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WANGLER
Provider First Name:
DAVID
Provider Middle Name:
MORGAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WANGLER
Provider Other First Name:
DAVID
Provider Other Middle Name:
JOSEPH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578851879
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1131 VALENCIA WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PACIFICA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94044-3534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-418-9191
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 POTRERO AVE
Provider Second Line Business Practice Location Address:
ATT: ANESTHESIA DEPARTMENT
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94110-3518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-418-9191
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  4157 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)