Provider Demographics
NPI:1730192931
Name:MCNEEL, WAKELIN III
Entity type:Individual
Prefix:
First Name:WAKELIN
Middle Name:
Last Name:MCNEEL
Suffix:III
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 1:750 TERRADO PLAZA
Mailing Address - Street 2:STE 40
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723
Mailing Address - Country:US
Mailing Address - Phone:626-332-0556
Mailing Address - Fax:626-332-6587
Practice Address - Street 1:4619 ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770
Practice Address - Country:US
Practice Address - Phone:626-286-1191
Practice Address - Fax:626-287-7486
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG789332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G789330Medicaid
G78933Medicare ID - Type Unspecified
U46730Medicare UPIN