Provider Demographics
NPI:1528004199
Name:WIGGINS, THOMAS M (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:WIGGINS
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 1:11999 SAN VICENTE BL.
Mailing Address - Street 2:STE. 440
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5042
Mailing Address - Country:US
Mailing Address - Phone:310-440-3131
Mailing Address - Fax:310-472-9582
Practice Address - Street 1:2300 WANKEL WAY
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93031-6225
Practice Address - Country:US
Practice Address - Phone:805-485-1908
Practice Address - Fax:805-485-5767
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG18195207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G181950Medicaid
CA00G181950Medicaid