Provider Demographics
NPI:1932361508
Name:WAHLE, PATRICIA RUTH (DO)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:RUTH
Last Name:WAHLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 RAYMOND AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-5752
Mailing Address - Country:US
Mailing Address - Phone:909-469-9494
Mailing Address - Fax:
Practice Address - Street 1:1770 N ORANGE GROVE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3027
Practice Address - Country:US
Practice Address - Phone:909-469-9494
Practice Address - Fax:909-629-6087
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program