Provider Demographics
NPI:1235313396
Name:WELTE, WILLIAM S (NMW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:S
Last Name:WELTE
Suffix:
Gender:M
Credentials:NMW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 YAQUI PASS ROAD
Mailing Address - Street 2:
Mailing Address - City:BORREGO SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92004-2369
Mailing Address - Country:US
Mailing Address - Phone:760-767-5051
Mailing Address - Fax:760-767-4552
Practice Address - Street 1:4343 YAQUI PASS ROAD
Practice Address - Street 2:
Practice Address - City:BORREGO SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92004-2369
Practice Address - Country:US
Practice Address - Phone:760-767-5051
Practice Address - Fax:760-767-4552
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANM1074367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife