Basic Information
| Provider Information | |||||||||
| NPI: | 1457308769 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAHLEN | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 511470 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900518025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5125830205 | ||||||||
| FaxNumber: | 5125832001 | ||||||||
| Practice Location | |||||||||
| Address1: | 265 COHASSET RD | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959262273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308918787 | ||||||||
| FaxNumber: | 5308989647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 02/09/2010 | ||||||||
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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 | 2085R0001X | RHL1388296 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 00G701900 | 05 | CA | MEDICAID | DW2615411 | 01 | DEA | OTHER | G70190 | 01 | CA | MEDICAL LICENSE | OTHER |