Provider Demographics
NPI:1578781746
Name:ROBIN C. WEDBERG MD APC
Entity Type:Organization
Organization Name:ROBIN C. WEDBERG MD APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:WEDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-220-0999
Mailing Address - Street 1:5030 CAMINO DE LA SIESTA
Mailing Address - Street 2:106
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3116
Mailing Address - Country:US
Mailing Address - Phone:619-220-0999
Mailing Address - Fax:619-220-8567
Practice Address - Street 1:5030 CAMINO DE LA SIESTA
Practice Address - Street 2:106
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3116
Practice Address - Country:US
Practice Address - Phone:619-220-0999
Practice Address - Fax:619-220-8567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37609207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15050Medicare ID - Type Unspecified
CAA91910Medicare UPIN