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GREGORY L WAKEMAN DO INC NPI 1669562765


NPI Information

NPI: 1669562765
Provider Name: GREGORY L WAKEMAN DO INC

Doing Business As: LA COSTA URGENT CARE AND FAMILY PRACTICE

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 05D2219094

Address:
6971 EL CAMINO REAL
SUITE 101
CARLSBAD, CA
ZIP 92009
Phone: (760) 603-3221
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GREGORY L WAKEMAN DO INC is a family medicine in Carlsbad, CA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. GREGORY L WAKEMAN DO INC NPI is 1669562765. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As La Costa Urgent Care And Family Practice.

The provider's business location address is:

6971 EL CAMINO REAL
SUITE 101
CARLSBAD, CA
ZIP 92009
Phone: (760) 603-3221
Fax: (760) 603-7719

The provider's authorized official is Gregory Lance Wakeman .
The authorized official title is Chief Executive Officer and has the following contact phone number (760) 603-3221.

The CLIA number assigned to this NPI record is 05D2219094 - other - life plan community with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/13/2006 and was last updated on 10/30/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily Medicine20A6797CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
120A6797MEDICARE PIN
2G46485MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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