Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | PA 18316 | CA |
NPI | 1467584532 |
---|---|
Provider Name | Wayne T. Dewri |
First Address | Loma Linda, CA 92354-0599 |
Second Address | Redlands, CA 92374-2881 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 07/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1467584532 | (05) | CA |