Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | A102223 | CA |
NPI | 1255543831 |
---|---|
Provider Name | Wessam Labib |
First Address | Los Angeles, CA 90074-4701 |
Second Address | Loma Linda, CA 92354-3128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 19/10/2015 |