Provider Demographics
NPI:1487890547
Name:WILSHIRE MEDICAL ARTS PA
Entity type:Organization
Organization Name:WILSHIRE MEDICAL ARTS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:BERRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-625-1275
Mailing Address - Street 1:425 CROSS ST
Mailing Address - Street 2:SUITE 311 & 312
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-4877
Mailing Address - Country:US
Mailing Address - Phone:941-625-1275
Mailing Address - Fax:
Practice Address - Street 1:425 CROSS ST
Practice Address - Street 2:SUITE 311 & 312
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4877
Practice Address - Country:US
Practice Address - Phone:941-625-1275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31998207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty