Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Wyatt Robert Wichman

Individual provider Occupational Medicine Clinic/Center · NPI 1265072904

Mr. Wyatt Robert Wichman is an Occupational Medicine Clinic/Center in Glendale, California. Practices as a sole proprietor. Licensed in California.

Licensed in
CA
In the registry since
2020
Specialties on file
2
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Practice location Address checks out

100 W Broadway Ste 750
Glendale, CA 91210-1215
Phone: (323) 419-4103
Fax: (323) 419-5507
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Clinic/Center (primary) Taxonomy 261QP2000X · Licence 03316548 (CA)
Occupational Medicine Clinic/Center Taxonomy 261QX0100X · Licence 03316548 (CA)

Record details

NPI number1265072904
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJanuary 10, 2020
Last updated in NPPESJanuary 14, 2020
Certification dateJanuary 14, 2020

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