Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | A98343 | CA |
NPI | 1073707212 |
---|---|
Provider Name | Benjamin William Walline |
First Address | Los Angeles, CA 90067-2001 |
Second Address | Los Angeles, CA 90067-2001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2007 |
Last Update Date | 16/10/2012 |