Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 18037 | CA |
NPI | 1033153044 |
---|---|
Provider Name | Dr. Wayne Joseph Hodges |
First Address | Lancaster, CA 93534-2814 |
Second Address | Lancaster, CA 93534-2312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 01/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
WDC0180370A | (02) | CA |