Individual
AVA MARIE WIEDEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9665 CHESAPEAKE DR STE 350, SAN DIEGO, CA 92123-1352
(877) 260-2261
Mailing address
2131 E GRETTA PL, PHOENIX, AZ 85022-3436
(602) 793-6456
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA57411
CA
Other
Enumeration date
10/23/2019
Last updated
11/08/2019
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