MEDICARE: CHRISTINE L WIGEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	A67851	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891880142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE L WIGEN M.D.

Provider Business Mailing Address
First Line	:	2615 S GRAND AVE
Second Line	:	ROOM 500
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-2608
Country	:	US
Telephone Number	:	213-744-3070
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 S GRAND AVE
Second Line	:	ROOM 500
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-2608
Country	:	US
Telephone Number	:	213-744-3070
Fax Number	:	213-749-9606

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	03/05/2010

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