Provider Demographics
NPI:1740313709
Name:WACHSMAN, ASHLEY MAX (MD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MAX
Last Name:WACHSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1525 RANCHO CONEJO BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-1441
Mailing Address - Country:US
Mailing Address - Phone:805-375-8800
Mailing Address - Fax:805-375-8900
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:ROOM M 335
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:310-423-6500
Practice Address - Fax:310-423-5654
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG816442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHL140281OtherDEPT OF HEALTH SERVICES
CA00G816440Medicaid
CA00G816440Medicaid
BW5972535OtherUS DEPT OF JUSTICE DEA
G98692Medicare UPIN