Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | C36085 | CA |
NPI | 1013995083 |
---|---|
Provider Name | Dr. Gerald Wasserwald |
First Address | Torrance, CA 90505-4909 |
Second Address | Torrance, CA 90505-4909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 07/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A36164 | (02) | |
ZZZ495482 | (05) | CA |