Individual
JEREMY WILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3570 E 18TH ST APT 303, ANTIOCH, CA 94509-7448
(925) 504-7968
Mailing address
3570 E 18TH ST APT 303, ANTIOCH, CA 94509-7448
(925) 504-7968
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
002973429
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002973429
—
CA
Enumeration date
03/01/2025
Last updated
03/01/2025
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