Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G28846 | CA |
NPI | 1124054788 |
---|---|
Provider Name | Wilson Del Pizzo |
First Address | Van Nuys, CA 91405-3796 |
Second Address | Van Nuys, CA 91405-3796 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 24/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A43880 | (02) | CA |