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General NPI Number Information
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NPI Number | 1750313359
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Entity Type | Individual
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Provider Name | DOUGLAS BRYAN WESSON ACA
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Gender | Male
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1079 EUCALYPTUS ST SUITE B
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City | MANTECA
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State | CA
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Zip | 95337-4369
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Country | US
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Telephone | 209-823-2107
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Fax | 209-823-0563
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Provider Business Mailing Address
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Address Line | 1079 EUCALYPTUS ST SUITE B
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City | MANTECA
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State | CA
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Zip | 95337-4369
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Country | US
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Telephone | 209-823-2107
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Fax | 209-823-0563
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HA1161
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License Number State | CA
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