Doctor Name: | PATRICIA RUTH WAHLE |
NPI Number: | 1932361508 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DO |
License Number: | |
Business Practice Address: | 1770 N Orange Grove Ave Suite 101 Pomona, CA - 917673027 |
Business Phone Number: | 9094699494 |
Business Fax Number: | 9096296087 |
Mailing Address: | 2104 Raymond Ave, Apt 2 ALTADENA |
State: | CA |
Postal Code: | 910015752 |
Phone Number: | 9094699494 |
Fax Number: | |
NPI Enumeration Date: | 06/25/2008 |
NPI Last Update Date: | 06/25/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |