Organization
LIBBY WILSON MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIBBY F WILSON M.D. (PRESIDENT)
(213) 742-1433
Entity
Organization
Contact information
Practice address
403 W ADAMS BLVD, LOS ANGELES, CA 90007-2664
(213) 742-1433
(213) 742-1496
Mailing address
403 W ADAMS BLVD, LOS ANGELES, CA 90007-2664
(213) 742-1433
(213) 742-1496
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
G18778
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G187780
—
CA
Enumeration date
01/20/2015
Last updated
01/20/2015
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