Provider Demographics
NPI:1619956927
Name:WISNOFF, WARREN JASON (DO)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:JASON
Last Name:WISNOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7702 MEANY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-5198
Mailing Address - Country:US
Mailing Address - Phone:661-843-7830
Mailing Address - Fax:661-843-7831
Practice Address - Street 1:7702 MEANY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5198
Practice Address - Country:US
Practice Address - Phone:661-843-7830
Practice Address - Fax:661-843-7831
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9093207P00000X, 207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX90930Medicaid
CAAN893ZOtherMEDICARE PTAN-SOUTHWEST
CAAN893YOtherMEDICARE PTAN-URGENT CARE
CA020A90930Medicare PIN
CAH75317Medicare UPIN