Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | G54949 | CA |
NPI | 1013942986 |
---|---|
Provider Name | George W. Wesley |
First Address | Orange, CA 92868-4228 |
Second Address | Orange, CA 92868-4228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 07/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A93335 | INDIVIDUAL (01) | CA |
AW3038519 | DEA (01) | CA |
G54949 | MEDICAL LICENSE (01) | CA |
GR0064090 | (05) | CA |
W13178 | (02) | CA |