Provider Demographics
NPI:1407868433
Name:WEXLEY, LILIA REGINA (MD)
Entity Type:Individual
Prefix:MRS
First Name:LILIA
Middle Name:REGINA
Last Name:WEXLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 N FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-7261
Mailing Address - Country:US
Mailing Address - Phone:323-655-3933
Mailing Address - Fax:323-655-9725
Practice Address - Street 1:739 N FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-7261
Practice Address - Country:US
Practice Address - Phone:323-655-3933
Practice Address - Fax:323-655-9725
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45560207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A455600Medicaid
A45560Medicare ID - Type Unspecified
CA00A455600Medicaid
E17539Medicare UPIN