Basic Information
| Provider Information | |||||||||
| NPI: | 1659535656 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WYSOCZANSKI | ||||||||
| FirstName: | MARIUSZ | ||||||||
| MiddleName: | WITOLD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 754 MEDICAL CENTER CT STE 204 | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919116656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196162100 | ||||||||
| FaxNumber: | 6196162104 | ||||||||
| Practice Location | |||||||||
| Address1: | 754 MEDICAL CENTER CT STE 204 | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919116656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196162100 | ||||||||
| FaxNumber: | 6196162104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2008 | ||||||||
| LastUpdateDate: | 11/28/2014 | ||||||||
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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 | 207UN0901X | C55986 | CA | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | 207RC0000X | C55986 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207R00000X | C55986 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.