Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A128971 | CA |
N | 111NI0900X | Internist | A128971 | CA |
Y | 207RG0100X | Gastroenterologist | A128971 | CA |
NPI | 1033479795 |
---|---|
Provider Name | Didi Mwengela |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Torrance, CA 90505-7528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2012 |
Last Update Date | 12/07/2019 |