Provider Demographics
NPI:1922215045
Name:TOM, WYNNIS L (MD)
Entity Type:Individual
Prefix:DR
First Name:WYNNIS
Middle Name:L
Last Name:TOM
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3860 CALLE FORTUNADA
Mailing Address - Street 2:STE #210
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4802
Mailing Address - Country:US
Mailing Address - Phone:858-309-6303
Mailing Address - Fax:858-309-6301
Practice Address - Street 1:8010 FROST ST
Practice Address - Street 2:STE 602
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2778
Practice Address - Country:US
Practice Address - Phone:858-966-6795
Practice Address - Fax:858-966-4040
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2011-09-19
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Provider Licenses
StateLicense IDTaxonomies
CAA99290207NP0225X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology