Provider Demographics
NPI:1083640213
Name:WAHIDULLAH, WAHIDULLAH (MD)
Entity Type:Individual
Prefix:
First Name:WAHIDULLAH
Middle Name:
Last Name:WAHIDULLAH
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 1:1548 HILLSBOROUGH ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ST JOSEPH HOSPITAL - EUREKA
Practice Address - Street 2:2700 DOLBEER ST
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4799
Practice Address - Country:US
Practice Address - Phone:707-445-8121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86761208M00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A867610Medicare ID - Type Unspecified
CAI20013Medicare UPIN