Individual
MIKE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ORTHOPEDIC TECH
Contact information
Practice address
317 N EL CAMINO REAL, STE 405, ENCINITAS, CA 92024-2811
(760) 994-2663
Mailing address
317 N EL CAMINO REAL, STE 405, ENCINITAS, CA 92024-2811
(760) 994-2663
Taxonomy
Speciality
Code
Description
License number
State
246ZX2200X
Orthopedic Assistant
Primary
CPT00039417
TX
Other
Enumeration date
04/04/2017
Last updated
04/04/2017
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