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General NPI Number Information
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NPI Number | 1851505432
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Entity Type | Organization
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Legal Business Name | P. PERRY WICH, M.D., INC.
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 630 N 13TH AVE SUITE F
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City | UPLAND
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State | CA
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Zip | 91786-4975
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Country | US
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Telephone | 909-946-3826
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Fax | 909-949-4457
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Provider Business Mailing Address
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Address Line | 630 N 13TH AVE SUITE F
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City | UPLAND
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State | CA
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Zip | 91786-4975
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Country | US
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Telephone | 909-946-3826
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Fax | 909-949-4457
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. P. PERRY WICH
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Credential | M.D.
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Telephone | 909-946-3826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | A32660
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License Number State | CA
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