Provider Demographics
NPI:1487692158
Name:WOLBERS AND POREE MEDICAL CORP
Entity type:Organization
Organization Name:WOLBERS AND POREE MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOLBERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-296-5700
Mailing Address - Street 1:2425 PORTER ST STE 11
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2453
Mailing Address - Country:US
Mailing Address - Phone:831-296-5700
Mailing Address - Fax:831-296-5701
Practice Address - Street 1:2425 PORTER ST
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2444
Practice Address - Country:US
Practice Address - Phone:831-296-5700
Practice Address - Fax:831-296-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA352198100OtherUS DEPT OF LABOR