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Individual

RAFAEL WILSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1447 CALLE CIBOLA, SIERRA VISTA, AZ 85635-9301
(702) 296-5724
Mailing address
1447 CALLE CIBOLA, SIERRA VISTA, AZ 85635-9301
(702) 296-5724

Taxonomy

Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
CGL5363
AZ

Other

Enumeration date
06/04/2019
Last updated
06/04/2019
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