Provider Demographics
NPI:1124039029
Name:WENNEKER & LOFTUS INC
Entity Type:Organization
Organization Name:WENNEKER & LOFTUS INC
Other - Org Name:SURGERY GROUP OF NAPA VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-226-2031
Mailing Address - Street 1:3443 VILLA LANE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6417
Mailing Address - Country:US
Mailing Address - Phone:707-226-2034
Mailing Address - Fax:707-252-1087
Practice Address - Street 1:3443 VILLA LANE
Practice Address - Street 2:SUITE 3
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6417
Practice Address - Country:US
Practice Address - Phone:707-226-2034
Practice Address - Fax:707-252-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208600000X, 2086S0129X
CAC5292802086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083940Medicaid
CAZZZ55854ZOtherBLUE SHIELD
CAGR0083940Medicaid