Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 35.129239 | OH |
Y | 2086S0102X | Surgical Critical Care | A155210 | CA |
NPI | 1114330370 |
---|---|
Provider Name | Matthew Diarmuid Wiepking |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90033-5313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2014 |
Last Update Date | 11/09/2020 |