Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A132434 | CA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A132434 | CA |
NPI | 1205279908 |
---|---|
Provider Name | Sean M Wahlquist |
First Address | Folsom, CA 95630-3541 |
Second Address | Folsom, CA 95630-3541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2013 |
Last Update Date | 23/07/2019 |