Search › California › 1041C0700X
Wanda Boutte
NPI 1376980227 · on the registry since 2013 · sole proprietor
Practice
- Address
- 5241 Medea Way
Antioch, CA 94531 - Phone
- (510) 469-1136
Registry record
- Primary taxonomy
- 1041C0700X
1041C0700X
- Also registered as
- 222Q00000X
- Licence states on file
- NULL, CA
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2024-11-22
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California