Individual
WES R WILTSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1 QUALITY DR, B36, VACAVILLE, CA 95688-9494
(707) 684-3840
Mailing address
1 QUALITY DR, B36, VACAVILLE, CA 95688-9494
(707) 684-3840
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
20A11522
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12213920
CAQH PROVIDER NUMBER
CA
01
—
20A11522
OSTEO MEDICAL BOARD LICENSE
CA
01
—
9796759
AETNA PROVIDER NUMBER
—
Enumeration date
01/19/2010
Last updated
12/15/2021
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