Provider Demographics
NPI:1134651573
Name:WLED WAZNI, M.D. MEDICAL CORPORATION
Entity Type:Organization
Organization Name:WLED WAZNI, M.D. MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WLED
Authorized Official - Middle Name:
Authorized Official - Last Name:WAZNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-303-5519
Mailing Address - Street 1:478 S OAKLAND AVE
Mailing Address - Street 2:UNIT 3
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-4032
Mailing Address - Country:US
Mailing Address - Phone:586-303-5519
Mailing Address - Fax:
Practice Address - Street 1:1050 LINDEN AVE FL 2
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3321
Practice Address - Country:US
Practice Address - Phone:562-491-9270
Practice Address - Fax:562-491-7985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular NeurologyGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty