Provider Demographics
NPI:1942672407
Name:WIESENBERG, MARIA MARGARITA LANDICHO (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARIA MARGARITA
Middle Name:LANDICHO
Last Name:WIESENBERG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MARIA MARGARITA
Other - Middle Name:
Other - Last Name:LANDICHO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:474 W VERMONT AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6584
Mailing Address - Country:US
Mailing Address - Phone:760-270-9068
Mailing Address - Fax:442-262-3457
Practice Address - Street 1:474 W VERMONT AVE STE 104
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6584
Practice Address - Country:US
Practice Address - Phone:760-270-9068
Practice Address - Fax:442-262-3457
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist