Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | F7664 | TX |
NPI | 1285017343 |
---|---|
Provider Name | Dr. Leilani So Wiltz |
First Address | Dallas, TX 75225 |
Second Address | Dallas, TX 75225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2015 |
Last Update Date | 07/07/2015 |