Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | G81350 | CA |
N | 2086S0122X | Plastic and Reconstructive Surgery | G81350 | CA |
NPI | 1255435822 |
---|---|
Provider Name | Mr. David L Wirta |
First Address | Newport Beach, CA 92663 |
Second Address | Newport Beach, CA 92648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 08/07/2007 |