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NPI Code Detail

MEDICARE: MRS. BRIGITTE KARIN WOLVERTON PA-C

MEDICARE: MRS. BRIGITTE KARIN WOLVERTON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA15094CA

General Provider Information

NPI Number : 1154474716
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BRIGITTE KARIN WOLVERTON PA-C
Provider Business Mailing Address
First Line : 5620 VISTA DEL MAR
Second Line :
City : YORBA LINDA
State : CA
Zip : 92887-3266
Country : US
Telephone Number : 714-334-4696
Fax Number :
Provider Business Practice Location Address
First Line : 3851 S SOTO ST
Second Line :
City : VERNON
State : CA
Zip : 90058-1718
Country : US
Telephone Number : 323-585-7162
Fax Number : 323-585-0167
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2007
Last Update Date : 06/21/2016

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