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Individual

TARA L WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
3660 PARK SIERRA DR, SUITE 105, RIVERSIDE, CA 92505-3071
(951) 278-8870
(951) 278-8913
Mailing address
P.O. BOX 2828, CORONA, CA 92878-2828
(951) 278-8870
(951) 278-8913

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A80520
CA

Other

Enumeration date
10/04/2006
Last updated
12/22/2021
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