Individual
TRACEY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RCFE
Contact information
Practice address
639 S GREGORY ST, SAN DIEGO, CA 92113-2617
(619) 693-9080
(619) 393-2177
Mailing address
864 GRAND AVE # 802, SAN DIEGO, CA 92109-3906
(619) 357-6472
Taxonomy
Speciality
Code
Description
License number
State
376G00000X
Nursing Home Administrator
Primary
6029334740
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6029334740
RCFE ADMINISTRATOR CERTIFICATION
CA
Enumeration date
11/02/2017
Last updated
11/02/2017
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