Provider Demographics
NPI:1255435822
Name:WIRTA, DAVID L (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:WIRTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1501 SUPERIOR AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663
Mailing Address - Country:US
Mailing Address - Phone:949-650-1863
Mailing Address - Fax:949-650-4359
Practice Address - Street 1:520 SUPERIOR AVE STE 235
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3642
Practice Address - Country:US
Practice Address - Phone:949-650-1863
Practice Address - Fax:949-650-4359
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81350207W00000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Not Answered2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G81350CMedicare ID - Type Unspecified