Street, Wendell Mark
Street, Wendell Mark is an sole proprietor health care provider with primary practice located at 14075 Hesperia Rd Suite 205, Victorville CA 92395-4500. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pain Medicine, which is considered as his primary health care specialty. Street, Wendell Mark can be contacted via phone (760) 596-3708.Contact Information
Primary practice address
14075 Hesperia Rd Suite 205
Victorville CA 92395-4500
Phone: (760) 596-3708
Fax: (760) 596-3731
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pain Medicine | 207LP2900X | A43837 | California |
Profile Details
| NPI number | 1437240314 |
|---|---|
| LBN Legal business name | Street, Wendell Mark |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 27th, 2006 |
| Last updated | Jul 26th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1437240314 | NPPES |
| California | Other | 330619189 | FEDERAL TAX ID |
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