Individual
JAKE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1600 W AVENUE J, LANCASTER, CA 93534
(661) 949-5000
Mailing address
1128 OCEAN PARK BLVD APT 201, SANTA MONICA, CA 90405-4765
(512) 470-6262
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A141468
CA
207P00000X
Emergency Medicine Physician
MD61413870
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
03/25/2014
Last updated
03/21/2023
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