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General NPI Number Information
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NPI Number | 1104446624
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Entity Type | Individual
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Provider Name | ADAM WOOTTON ARRT(R)(MR)
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Gender | Male
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Dates
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Enumeration Date | 04/24/2020
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Last Update Date | 04/24/2020
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Provider Practice Location Address
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Address Line | 6640 ALTON PKWY
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City | IRVINE
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State | CA
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Zip | 92618-3734
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Country | US
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Telephone | 714-928-7715
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Fax |
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Provider Business Mailing Address
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Address Line | 370 HENDRICKS CIR
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City | CORONA
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State | CA
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Zip | 92879-6102
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | RHF00090808
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License Number State | CA
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