Organization
GENESIS OBGYN MEDICAL GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS WANDA ALTHEA WILBURN MD (OWNER OF MEDICAL PRACTICE)
(760) 946-3806
Entity
Organization
Contact information
Practice address
16000 APPLE VALLEY ROAD, SUITE C3, APPLE VALLEY, CA 92307
(760) 946-3806
(760) 946-3809
Mailing address
16000 APPLE VALLEY ROAD, SUITE C3, APPLE VALLEY, CA 92307
(760) 946-3806
(760) 946-3809
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
A84253
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A842530
—
CA
Enumeration date
10/04/2006
Last updated
11/29/2011
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