Basic Information
| Provider Information | |||||||||
| NPI: | 1043319866 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WLODARCZYK | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 230 SAN JOSE ST | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939013901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317582100 | ||||||||
| FaxNumber: | 8317581565 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 SAN JOSE ST | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939013901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317582100 | ||||||||
| FaxNumber: | 8317581565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 03/30/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 20A6483 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 00AX64831 | 05 | CA | MEDICAID | 060029696 | 01 | CA | RAILROAD MEDICARE | OTHER | 020A64833 | 01 | MEDICARE PTAN | OTHER |