Provider Demographics
NPI:1528297009
Name:WAZNI, WLED (MD)
Entity type:Individual
Prefix:
First Name:WLED
Middle Name:
Last Name:WAZNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:478 S OAKLAND AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-4032
Mailing Address - Country:US
Mailing Address - Phone:586-303-5519
Mailing Address - Fax:626-566-2866
Practice Address - Street 1:1050 LINDEN AVE FL 2
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3321
Practice Address - Country:US
Practice Address - Phone:562-491-9270
Practice Address - Fax:562-491-7985
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI60928 - 202084A2900X
CAA1471662084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1528297009Medicaid
WIK400150159Medicare PIN