Individual
WING IP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
847 W CHILDS AVE, MERCED, CA 95341-6862
(209) 383-7441
(209) 383-7813
Mailing address
737 W CHILDS AVE, MERCED, CA 95341-6805
(209) 385-5481
(209) 383-1296
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
5145
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5145
LICENSE
CA
Enumeration date
05/06/2013
Last updated
07/03/2014
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