Healthcare Provider Details

I. General information

NPI: 1861441925
Provider Name (Legal Business Name): WES J POWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S ARROYO PKWY FL 3
PASADENA CA
91105-3932
US

IV. Provider business mailing address

950 S ARROYO PKWY FL 3
PASADENA CA
91105-3932
US

V. Phone/Fax

Practice location:
  • Phone: 626-765-6944
  • Fax: 626-449-4607
Mailing address:
  • Phone: 626-765-6944
  • Fax: 626-449-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA46628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: