Provider Demographics
NPI:1134228984
Name:ROBERT WLODARCZYK, D.O., INC
Entity type:Organization
Organization Name:ROBERT WLODARCZYK, D.O., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:WLODARCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:831-771-9055
Mailing Address - Street 1:535 E ROMIE LN
Mailing Address - Street 2:# 6
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4026
Mailing Address - Country:US
Mailing Address - Phone:831-771-9055
Mailing Address - Fax:831-771-9053
Practice Address - Street 1:535 E ROMIE LN
Practice Address - Street 2:# 6
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4026
Practice Address - Country:US
Practice Address - Phone:831-771-9055
Practice Address - Fax:831-771-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6483207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX64831Medicaid
CAZZZ06304ZOtherMEDICARE PTAN