Individual
KATHY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2683 PACIFIC AVE, LONG BEACH, CA 90806-2610
(323) 404-4884
Mailing address
2683 PACIFIC AVE, SUITE A, LONG BEACH, CA 90806-2610
(323) 404-4884
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
A119319
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808130
—
CA
Enumeration date
06/10/2008
Last updated
01/14/2016
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