Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | A32660 | CA |
NPI | 1043317217 |
---|---|
Provider Name | Mr. Peiruch Perry Wich |
First Address | Upland, CA 91786-4975 |
Second Address | Upland, CA 91786-4975 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8208912 | (05) | CA |
D34034 | (02) |