Healthcare Provider Details

I. General information

NPI: 1134133978
Provider Name (Legal Business Name): JAMES D WETHE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 LOMITA BLVD SUITE 220
TORRANCE CA
90505-4818
US

IV. Provider business mailing address

3440 LOMITA BLVD SUITE 220
TORRANCE CA
90505-4818
US

V. Phone/Fax

Practice location:
  • Phone: 310-784-8389
  • Fax: 310-784-8399
Mailing address:
  • Phone: 310-784-8389
  • Fax: 310-784-8399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberGO46773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: