Individual
HAROLD T WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
16063 VANOWEN ST, VAN NUYS, CA 91406-4810
(818) 785-9989
(818) 785-3330
Mailing address
16063 VANOWEN ST, VAN NUYS, CA 91406-4810
(818) 785-9989
(818) 785-3330
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
A 38694
CA
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
9701199
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619960457
TRICARE
—
05
—
1619960457
—
SC
05
—
5910044
—
NC
Enumeration date
08/26/2005
Last updated
10/03/2013
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