Individual
ANDREW JAMES WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPT
Contact information
Practice address
2008 N GAREY AVE, POMONA, CA 91767-2722
(909) 623-6131
Mailing address
2008 N GAREY AVE, POMONA, CA 91767-2722
(909) 623-6131
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
41595
CA
Other
Enumeration date
03/18/2024
Last updated
03/18/2024
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