# B. GALE WILSON MTU

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699401018
- **Authorized official:** SHEKA JONES-ESPY (PHN MANAGER)
- **Authorized official phone:** (707) 784-8653

## Contact information

- **Practice address:** 3305 CHERRY HILLS CT, FAIRFIELD, CA 94534-7870
- **Practice address phone:** (707) 784-8650
- **Practice address fax:** (707) 421-7484
- **Mailing address:** 275 BECK AVE \# MS 5-175, FAIRFIELD, CA 94533-6804

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/27/2022
- **Last updated:** 07/27/2022