Individual
SHANE RICHARD WURDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CP
Contact information
Practice address
11301 WILSHIRE BLVD, BLDG 304, LOS ANGELES, CA 90073-1003
(310) 478-3711
Mailing address
1323 14TH ST, APT. E, SANTA MONICA, CA 90404-1744
(310) 478-3711
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
CP003610
CA
Other
Enumeration date
07/29/2008
Last updated
07/29/2008
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