Provider Demographics
NPI:1457308769
Name:WAHLEN, STEVEN A (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:WAHLEN
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:PO BOX 511470
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-8025
Mailing Address - Country:US
Mailing Address - Phone:512-583-0205
Mailing Address - Fax:512-583-2001
Practice Address - Street 1:265 COHASSET RD
Practice Address - Street 2:SUITE 140
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2273
Practice Address - Country:US
Practice Address - Phone:530-891-8787
Practice Address - Fax:530-898-9647
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHL13882962085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G701900Medicaid
CAG70190OtherMEDICAL LICENSE
CAG70190OtherMEDICAL LICENSE
CA00G701900Medicaid