Organization Active NPI

Wondermed of Texas, P.a.

  • Psychiatry Physician
  • Venice, CA
National Provider Identifier
1801508254
Registry record updated Dec 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
WONDERMED OF TEXAS, P.A.
Practice address
828 Crestmoore PL
Venice, CA 90291-4931
Phone
(424) 410-8475
NPI assigned
Dec 16, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2022

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

Authorized official

Name
Abraham Malkin, MD
Title
President
Phone
(786) 269-5501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

828 Crestmoore PL
Venice, CA 90291-4931

Mailing address

701 Tillery St Ste 12
Austin, TX 78702-3751

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1671148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671148800000",
    "number": "1801508254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 TILLERY ST STE 12",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787023751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828 CRESTMOORE PL",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902914931",
            "telephone_number": "424-410-8475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WONDERMED OF TEXAS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-16",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A",
        "authorized_official_last_name": "MALKIN",
        "authorized_official_first_name": "ABRAHAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "786-269-5501",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Venice, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2022; 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.