Individual
BRIANNA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, CSSD
Contact information
Practice address
316 SOUTH STRATFORD AVENUE, SUITE B, SANTA MARIA, CA 93454-5908
(805) 332-8446
(805) 332-8173
Mailing address
117 W BUNNY AVE, SANTA MARIA, CA 93458-2805
(805) 332-8446
(805) 332-8173
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1008492
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB235337
MEDICARE ID
CA
Enumeration date
11/22/2013
Last updated
12/26/2015
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