Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | C34429 | CA |
NPI | 1013909621 |
---|---|
Provider Name | Mr. Andrew Willis Wertz |
First Address | Sacramento, CA 95833-3668 |
Second Address | Sacramento, CA 95816-6039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 15/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C344290 | (05) | CA |
A35619 | (02) |