Individual
JOHNETTE B. WILSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.T.
Contact information
Practice address
2923 75TH AVE, OAKLAND, CA 94605-2903
(415) 571-0542
Mailing address
2923 75TH AVE, PO BOX 5056, OAKLAND, CA 94605-2903
(415) 571-0542
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
176908
CA
247100000X
Radiologic Technologist
Primary
44981
CA
Other
Enumeration date
07/13/2008
Last updated
07/13/2008
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