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General NPI Number Information
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NPI Number | 1467679977
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Entity Type | Organization
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Legal Business Name | WOLBERS AND POREE MEDICAL CORP
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 10/30/2013
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Provider Practice Location Address
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Address Line | 9057C SOQUEL DR SUITE # A
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City | APTOS
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State | CA
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Zip | 95003-4052
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Country | US
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Telephone | 831-684-0600
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Fax | 831-684-0606
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Provider Business Mailing Address
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Address Line | 9057C SOQUEL DR SUITE # A
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City | APTOS
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State | CA
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Zip | 95003-4052
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Country | US
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Telephone | 831-684-0600
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Fax | 831-684-0606
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Authorized Official
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Title or Position | CEO
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Name | DR. LINDA L WOLBERS
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Credential | M.D.
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Telephone | 831-684-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | G80646
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | A66092
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License Number State | CA
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