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Organization
P NICK WILSON MD INC
Active
Organization
P NICK WILSON MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL NICHOLAS WILSON M.D. (OWNER/ PRESIDENT)
(310) 792-3914
Entity
Organization
Contact information
Practice address
25500 MEDICAL CENTER DR, MURRIETA, CA 92562-5965
(951) 696-6000
(855) 898-4055
Mailing address
PO BOX 3098, TORRANCE, CA 90510-3098
(310) 792-3914
(855) 898-4055
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
615-07-2225
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DR543Z
MEDICARE PTAN
CA
Enumeration date
05/22/2012
Last updated
06/05/2012
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