Doctor Name: | MARY K. WILDE |
NPI Number: | 1508901810 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | G65602 |
Business Practice Address: | 9850 Genesee Ave Ste 510 La Jolla, CA - 920371213 |
Business Phone Number: | 8586232345 |
Business Fax Number: | 8586232343 |
Mailing Address: | 9850 Genesee Ave Ste 510, LA JOLLA |
State: | CA |
Postal Code: | 920371213 |
Phone Number: | 8586232345 |
Fax Number: | 8586232343 |
NPI Enumeration Date: | 02/21/2007 |
NPI Last Update Date: | 11/28/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | G65602 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |