Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 95003653 | CA |
NPI | 1013407170 |
---|---|
Provider Name | Carly Beth Welch |
First Address | San Diego, CA 92109-1719 |
Second Address | Vista, CA 92084-5218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2018 |
Last Update Date | 15/05/2018 |