Provider Demographics
NPI:1689879587
Name:ZDZISLAUS J. WANSKI, M.D.
Entity Type:Organization
Organization Name:ZDZISLAUS J. WANSKI, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-745-6047
Mailing Address - Street 1:1414 S GRAND AVE
Mailing Address - Street 2:SUITE 456
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3067
Mailing Address - Country:US
Mailing Address - Phone:213-745-6047
Mailing Address - Fax:213-748-9715
Practice Address - Street 1:1414 S GRAND AVE
Practice Address - Street 2:SUITE 456
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3067
Practice Address - Country:US
Practice Address - Phone:213-745-6047
Practice Address - Fax:213-748-9715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A41629207Q00000X
CAG36872207RE0101X
CAPA18399363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083400Medicaid
CAGR0083400Medicaid
CAW14510Medicare ID - Type Unspecified
CAWG36872DMedicare PIN