Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RX0202X | Medical Oncology | A49021 | CA |
Y | 207RX0202X | Medical Oncology | CP203502 | OR |
NPI | 1144205295 |
---|---|
Provider Name | Dr. Deepika Wali |
First Address | Portland, OR 97208-2120 |
Second Address | Klamath Falls, OR 97601-1123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 22/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A490210 | BCBS (01) | CA |
BU558W | MCARE PTAN (01) | CA |
G75405 | (02) | CA |