Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | A164113 | CA |
Y | 111NI0900X | Internist | A164113 | CA |
NPI | 1003311929 |
---|---|
Provider Name | Katherine Desprez Wick |
First Address | Sacramento, CA 95817 |
Second Address | Sacramento, CA 95817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2018 |
Last Update Date | 14/08/2019 |