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General NPI Number Information
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NPI Number | 1295939064
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Entity Type | Organization
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Legal Business Name | ASHLEY P. WILDE, MD
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 07/23/2008
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Provider Practice Location Address
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Address Line | 9542 ARTESIA BLVD
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City | BELLFLOWER
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State | CA
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Zip | 90706-6511
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Country | US
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Telephone | 562-925-8355
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3999
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City | TORRANCE
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State | CA
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Zip | 90510-3999
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Country | US
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Telephone | 310-792-3914
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Fax | 310-792-3621
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ASHLEY PAUL WILDE
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Credential | M.D.
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Telephone | 310-792-3914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G79378
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License Number State | CA
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