Provider Demographics
NPI:1003836651
Name:WOHLGELERNTER, DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:WOHLGELERNTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 212E
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2225
Mailing Address - Country:US
Mailing Address - Phone:310-401-3390
Mailing Address - Fax:310-453-4348
Practice Address - Street 1:1301 20TH ST
Practice Address - Street 2:SUITE 590
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2050
Practice Address - Country:US
Practice Address - Phone:310-315-0101
Practice Address - Fax:310-453-4145
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55314174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G553140Medicaid
CA952976030OtherGROUP TAX IDENTIFICATION
CAA93362Medicare UPIN
CAHW1249AMedicare PIN
CAWG55314CMedicare PIN
CAWG55314BMedicare PIN
CAW1249Medicare PIN
CA952976030OtherGROUP TAX IDENTIFICATION
CAHW1249Medicare PIN