Organization
WILLOW PARTNERS MEDICAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUTAR K WALI MD (OWNER)
(909) 865-2626
Entity
Organization
Contact information
Practice address
155 W WILLOW ST, POMONA, CA 91768-1829
(909) 865-2626
(909) 865-2010
Mailing address
155 W WILLOW ST, POMONA, CA 91768-1829
(909) 865-2626
(909) 865-2010
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
A32290
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0081880
—
CA
Enumeration date
03/01/2007
Last updated
07/15/2010
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