Healthcare Provider Details

I. General information

NPI: 1366406381
Provider Name (Legal Business Name): DAISY WU DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 03/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 BROCKTON AVE STE 202
RIVERSIDE CA
92506-0103
US

IV. Provider business mailing address

PO BOX 80362
RANCHO SANTA MARGARITA CA
92688-0362
US

V. Phone/Fax

Practice location:
  • Phone: 951-751-9096
  • Fax: 951-848-9163
Mailing address:
  • Phone: 951-751-9096
  • Fax: 951-848-9163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: