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Individual

WILLIAM LOUSHION MCCOLLUM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
831 GULF AVE, WILMINGTON, CA 90744-4201
(424) 533-8484
Mailing address
831 GULF AVE, WILMINGTON, CA 90744-4201

Taxonomy

Speciality
Code
Description
License number
State
261QV0200X
VA Clinic/Center
3747A0650X
Attendant Care Provider
Primary
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
IDK
CA
Enumeration date
09/30/2019
Last updated
10/01/2019
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