Provider Demographics
NPI:1306068374
Name:WENDEL, ISADORE (PHD)
Entity type:Individual
Prefix:DR
First Name:ISADORE
Middle Name:
Last Name:WENDEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 WILSHIRE BLVD.,
Mailing Address - Street 2:STE., 311
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3904
Mailing Address - Country:US
Mailing Address - Phone:213-250-5100
Mailing Address - Fax:213-250-8312
Practice Address - Street 1:1127 WILSHIRE BLVD.,
Practice Address - Street 2:STE., 311
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3904
Practice Address - Country:US
Practice Address - Phone:213-250-5100
Practice Address - Fax:213-250-8312
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7325103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01900POtherBLUE SHIELD PROVIDER NUM
CACP7725AMedicare ID - Type Unspecified