| NPI | 1093959900 |
|---|---|
| Former Legal Business Name | CLEFT PALATE PROGRAM MEDICAL PRACTICE GROUP |
| Entity Type | Organization |
| Authorized Contact | LIBBY F WILSON Plastic Surgeon 213-742-1433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Enumeration Date | 2009-04-22 |
| Last Update Date | 2015-08-18 |