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General NPI Number Information
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NPI Number | 1457661266
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Entity Type | Organization
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Legal Business Name | WAYNE L DOROTHY DPM INC
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Dates
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Enumeration Date | 10/14/2010
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | 12055 CALIFORNIA ST
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City | YUCAIPA
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State | CA
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Zip | 92399-3849
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Country | US
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Telephone | 909-797-0113
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Fax |
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Provider Business Mailing Address
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Address Line | 12055 CALIFORNIA ST
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City | YUCAIPA
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State | CA
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Zip | 92399-3849
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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 | DPM
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Name | DR. WAYNE LESTER DOROTHY
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Credential |
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Telephone | 909-797-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E1374
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License Number State | CA
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