Melissa Wibowo, MD
Family Medicine in Santa Clara, CA. Individual provider (NPI-1).
NPI number1336728658
StatusActive
Last updated in NPPESAug 22, 2024
Details
- NPI
- 1336728658
- Entity type
- Individual (NPI-1)
- Name
- Melissa Wibowo
- Credential
- MD
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 5, 2021
- Certification date
- Aug 22, 2024
- Last updated
- Aug 22, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | A183198 | CA | Yes |
Practice location
710 Lawrence ExpySanta Clara, CA 95051-5173
Phone 408-851-4163
Mailing address
710 Lawrence ExpySanta Clara, CA 95051-5173
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