Provider Demographics
NPI:1659535656
Name:WYSOCZANSKI, MARIUSZ WITOLD (MD)
Entity Type:Individual
Prefix:
First Name:MARIUSZ
Middle Name:WITOLD
Last Name:WYSOCZANSKI
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 1:1415 E 8TH ST STE 8
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2663
Mailing Address - Country:US
Mailing Address - Phone:619-434-4288
Mailing Address - Fax:
Practice Address - Street 1:1415 E 8TH ST STE 8
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2663
Practice Address - Country:US
Practice Address - Phone:619-434-4288
Practice Address - Fax:619-434-4315
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55986207R00000X, 207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology