Provider Demographics
NPI:1730479619
Name:WISNIEWSKI, JOY DAVIDA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOY
Middle Name:DAVIDA
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 GARDEN VIEW CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2481
Mailing Address - Country:US
Mailing Address - Phone:760-634-3376
Mailing Address - Fax:760-634-7955
Practice Address - Street 1:781 GARDEN VIEW CT
Practice Address - Street 2:SUITE 201
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2481
Practice Address - Country:US
Practice Address - Phone:760-634-3376
Practice Address - Fax:760-634-7955
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA137064174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist