Individual
WESLEY LIVINGSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4445 MAGNOLIA AVE, RIVERSIDE, CA 92501-4135
(714) 676-3880
(909) 614-8582
Mailing address
12223 HIGHLAND AVE STE 106-526, RANCHO CUCAMONGA, CA 91739-2574
(714) 676-3880
(909) 614-8582
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
19084
CA
207R00000X
Internal Medicine Physician
19084
CA
208M00000X
Hospitalist Physician
Primary
19084
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
390200000
—
NY
Enumeration date
03/31/2017
Last updated
11/02/2021
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