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General NPI Number Information
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NPI Number | 1326285651
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Entity Type | Organization
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Legal Business Name | PHILLIP WUNDER DO INC
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Dates
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Enumeration Date | 01/08/2009
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Last Update Date | 11/03/2010
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Provider Practice Location Address
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Address Line | 414 S PROSPECTORS RD STE A
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City | DIAMOND BAR
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State | CA
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Zip | 91765-1615
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Country | US
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Telephone | 909-860-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 23441 GOLDEN SPRINGS DR 533
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City | DIAMOND BAR
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State | CA
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Zip | 91765-2030
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Country | US
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Telephone | 909-860-8300
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PHILLIP WUNDER
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Credential |
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Telephone | 909-860-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A4967
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License Number State | CA
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