Provider Demographics
NPI:1780603761
Name:LAO, WILSON DUGADUGA (MD)
Entity type:Individual
Prefix:DR
First Name:WILSON
Middle Name:DUGADUGA
Last Name:LAO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11370 ANDERSON ST
Mailing Address - Street 2:SUITE 3615
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3450
Mailing Address - Country:US
Mailing Address - Phone:909-558-2481
Mailing Address - Fax:909-558-2608
Practice Address - Street 1:1238 E ARROW HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4951
Practice Address - Country:US
Practice Address - Phone:909-946-5348
Practice Address - Fax:909-946-6598
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAA56414207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG71915Medicare UPIN