Provider Demographics
NPI:1467619353
Name:WOZMAK, NICOLAS ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:ANTHONY
Last Name:WOZMAK
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 W M ST
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2707
Mailing Address - Country:US
Mailing Address - Phone:858-395-9327
Mailing Address - Fax:719-283-7966
Practice Address - Street 1:4 FINANCIAL PLZ
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3043
Practice Address - Country:US
Practice Address - Phone:707-266-7051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109605207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA119543Medicare PIN
CACA126579Medicare PIN