Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | A49216 | CA |
NPI | 1053491332 |
---|---|
Provider Name | Dr. Vijayalakshmi Wijeyakumar |
First Address | La Jolla, CA 92037-8411 |
Second Address | Fountain Valley, CA 92708-7506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 02/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F41803 | (02) | CA |