Individual
WESLEY P PHIPATANAKUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
25455 BARTON RD, SUITE 102B, LOMA LINDA, CA 92354-3128
(909) 558-2808
Mailing address
11406 LOMA LINDA DR, SUITE 218, LOMA LINDA, CA 92354-3711
(909) 558-6444
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
A81135
CA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
A81135
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A811350
—
CA
Enumeration date
06/24/2006
Last updated
05/30/2023
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