Individual
JACQUELINE A. WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CONTRACTOR
Contact information
Practice address
12257 MIDDLEBROOK SQ, SAN DIEGO, CA 92128-3759
(619) 922-7290
Mailing address
12257 MIDDLEBROOK SQ, SAN DIEGO, CA 92128-3759
(619) 922-7290
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
07/06/2011
Last updated
07/06/2011
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