Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | A55973 | CA |
NPI | 1043203730 |
---|---|
Provider Name | Dr. Kerri S Wiltchik |
First Address | Santa Maria, CA 93458-2805 |
Second Address | Santa Maria, CA 93454-8903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 23/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A559730 | (05) | CA |
CB219807 | MEDICARE ID (01) | CA |