Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | E4393 | CA |
NPI | 1407986995 |
---|---|
Provider Name | Dr. Gina L. Wilvang |
First Address | Artesia, CA 90702-0111 |
Second Address | Artesia, CA 90701-5440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U90569 | (02) | CA |