Healthcare Provider Details

I. General information

NPI: 1083117048
Provider Name (Legal Business Name): XIAOJIE WU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 HOSPITAL DR STE 207
UKIAH CA
95482-4568
US

IV. Provider business mailing address

11867 GONSALVES ST
CERRITOS CA
90703-7522
US

V. Phone/Fax

Practice location:
  • Phone: 707-463-7627
  • Fax:
Mailing address:
  • Phone: 562-350-6739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95008686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: