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1619990322
WISE FARGO
LOMA LINDA, CA
NPI
1619990322
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
208000000X Pediatrics
(Licence: CA A39502)
Enumeration Date
2006-07-25
Last Update Date
2007-07-08
Business Address
-- WISE FARGO M.D.
11370 ANDERSON ST STE B-100
LOMA LINDA, CA 92354-3450
Phone number: 909-558-2848
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Mailing Address
-- WISE FARGO M.D.
54701 FILE NUMBER
LOS ANGELES, CA 90074-4701
Phone number: 909-558-3111
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