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Organization

CRANIOFACIAL/CLEFT PALATE PROGRAM

Active
Other names
Cleft palate program medical practice group
Organization subpart
No

Provider details

NPI number
Authorized official
DR. LIBBY F WILSON M.D., (PLASTIC SURGEON)
(213) 742-1433
Entity
Organization

Contact information

Practice address
403 W ADAMS BLVD, 4TH FLOOR, LOS ANGELES, CA 90007-2664
(213) 742-1433
(213) 742-1496
Mailing address
403 W ADAMS BLVD, 4TH FLOOR, LOS ANGELES, CA 90007-2664
(213) 742-1433
(213) 742-1496

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary

Other

Enumeration date
04/22/2009
Last updated
08/18/2015
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