Individual
MR. GORDON WALLACE WAITE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5953 LANDIS AVE, CARMICHAEL, CA 95608-3821
(916) 487-5049
(916) 487-5049
Mailing address
5953 LANDIS AVE, CARMICHAEL, CA 95608-3821
(916) 487-5049
(916) 487-5049
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
673704
CA
Other
Enumeration date
05/23/2010
Last updated
05/23/2010
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