Provider Demographics
NPI:1346218625
Name:WIRGA, MARIUSZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIUSZ
Middle Name:
Last Name:WIRGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 LONG BEACH BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2020
Mailing Address - Country:US
Mailing Address - Phone:562-427-3897
Mailing Address - Fax:562-309-9998
Practice Address - Street 1:4201 LONG BEACH BLVD
Practice Address - Street 2:STE 203
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2020
Practice Address - Country:US
Practice Address - Phone:562-427-3897
Practice Address - Fax:562-309-9998
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA744872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG60445Medicare UPIN
CAWA74487OMedicare ID - Type Unspecified