Provider Demographics
NPI:1881673663
Name:ARD, WENDY M (PAC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:M
Last Name:ARD
Suffix:
Gender:F
Credentials:PAC
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Mailing Address - Street 1:23600 TELO AVE
Mailing Address - Street 2:260
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4035
Mailing Address - Country:US
Mailing Address - Phone:310-539-2055
Mailing Address - Fax:310-539-0199
Practice Address - Street 1:23600 TELO AVE
Practice Address - Street 2:260
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4035
Practice Address - Country:US
Practice Address - Phone:310-539-2055
Practice Address - Fax:310-539-0199
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA12058363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant