Individual
SEYMOURA RAYCHANEL WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRT HAIR LOSS SPT
Contact information
Practice address
3411 CRENSHAW BLVD APT 511, LOS ANGELES, CA 90016-4879
(323) 614-1465
Mailing address
1915 LEIGHTON AVE, LOS ANGELES, CA 90062-1316
(323) 614-1465
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
01/26/2021
Last updated
01/26/2021
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