Basic Information
| Provider Information | |||||||||
| NPI: | 1174530042 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WAHL | ||||||||
| FirstName: | GERALD | ||||||||
| MiddleName: | FRANCIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 SAN JOSE ST | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314240807 | ||||||||
| FaxNumber: | 8314243408 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 SAN JOSE ST | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314240807 | ||||||||
| FaxNumber: | 8314243408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 07/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | G215420 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | ZZZ70373Z | 05 | CA | MEDICAID | 94170316793901A004 | 01 | TRICARE | OTHER |