Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A62779 | CA |
NPI | 1508956889 |
---|---|
Provider Name | Dr. Wendell Harry |
First Address | Salinas, CA 93902-2879 |
Second Address | Salinas, CA 93906-3100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2006 |
Last Update Date | 08/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A62779 | CALIFORNIA LICENSE (01) | CA |
G84490 | (02) | CA |