Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | A133430 | CA |
NPI | 1003250002 |
---|---|
Provider Name | Kristen Michelle Wellington |
First Address | Los Angeles, CA 90084-7969 |
Second Address | Rancho Mirage, CA 92270-3221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2013 |
Last Update Date | 26/02/2020 |