Provider Demographics
NPI:1962929554
Name:WEHRLY, JOHN DALE
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DALE
Last Name:WEHRLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 710514
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92171-0514
Mailing Address - Country:US
Mailing Address - Phone:619-757-5257
Mailing Address - Fax:
Practice Address - Street 1:3539 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-7032
Practice Address - Country:US
Practice Address - Phone:619-818-3788
Practice Address - Fax:619-795-6906
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA484699163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse