Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1376730788 |
---|---|
Provider Name | Yolanda Wafer |
First Address | Fairfield, CA 94533 |
Second Address | Fairfield, CA 94533-4997 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2007 |
Last Update Date | 12/10/2007 |