Allan S. Wirtzer

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

261QA1903X Issued in CA

Legal business name

ALLAN S. WIRTZER

Practice address

4836 Van Nuys Blvd
Sherman Oaks, CA 91403-2101

Phone

(818) 907-7546

Fax

(818) 907-9506

NPI assigned

Apr 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Allan Stanley Wirtzer, M.D.

Title

Medical Director

Phone

(818) 907-7546

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MID VALLEY DERMATOLOGICAL SURGERY CENTER Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226534400000",
    "number": "1295792505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4836 VAN NUYS BLVD",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914032101",
            "telephone_number": "818-907-7546",
            "fax_number": "818-907-9506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4836 VAN NUYS BLVD",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914032101",
            "telephone_number": "818-907-7546",
            "fax_number": "818-907-9506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLAN S. WIRTZER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-28",
        "last_updated": "2008-11-13",
        "status": "A",
        "authorized_official_last_name": "WIRTZER",
        "authorized_official_first_name": "ALLAN",
        "authorized_official_middle_name": "STANLEY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "818-907-7546",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "261QA1903X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALLAN S. WIRTZER MD, MEDICAL DIRECTOR NPI#",
            "identifier": "1326003161",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MID VALLEY DERMATOLOGICAL SURGERY CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ambulatory Surgical Clinic/Center in Sherman Oaks, CA
• Providers in Sherman Oaks, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.