Provider Demographics
NPI:1225208606
Name:RHEUMATOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:RHEUMATOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WOLLASTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-980-7010
Mailing Address - Street 1:12660 RIVERSIDE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3429
Mailing Address - Country:US
Mailing Address - Phone:818-980-7010
Mailing Address - Fax:818-980-7330
Practice Address - Street 1:12660 RIVERSIDE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607-3430
Practice Address - Country:US
Practice Address - Phone:818-980-7010
Practice Address - Fax:818-980-7330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19587Medicare PIN