Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | A126925 | CA |
NPI | 1093036543 |
---|---|
Provider Name | Welim Sonye Azinge |
First Address | Santee, CA 92071-1901 |
Second Address | El Centro, CA 92243-1607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2010 |
Last Update Date | 21/09/2017 |