Provider Demographics
NPI:1669693693
Name:REISS WOZNAK MEDICAL CLINIC
Entity type:Organization
Organization Name:REISS WOZNAK MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:F
Authorized Official - Last Name:WOZNAK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:310-828-5571
Mailing Address - Street 1:1908 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-828-5571
Mailing Address - Fax:310-828-4247
Practice Address - Street 1:1908 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-828-5571
Practice Address - Fax:310-828-4247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC28067208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty