Provider Demographics
NPI:1366461832
Name:WACHS, BARTON HARRIS (MD)
Entity Type:Individual
Prefix:
First Name:BARTON
Middle Name:HARRIS
Last Name:WACHS
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 1:701 E 28TH ST
Mailing Address - Street 2:SUITE 319
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2759
Mailing Address - Country:US
Mailing Address - Phone:562-595-5977
Mailing Address - Fax:562-490-0509
Practice Address - Street 1:701 E 28TH ST
Practice Address - Street 2:SUITE 319
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2759
Practice Address - Country:US
Practice Address - Phone:562-595-5977
Practice Address - Fax:562-490-0509
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32052174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA32052AOtherMEDICARE PROVIDER ID
CA330114918OtherTAX IDENTIFICATION NUMBER
CA2405716Medicaid
CAA26684Medicare UPIN