Individual
KAREN L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3811 VALLEY CENTRE DR, SAN DIEGO, CA 92130
(858) 764-3030
Mailing address
3811 VALLEY CENTRE DR, SAN DIEGO, CA 92130-3318
(858) 764-3030
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
036103153
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036103153
—
IL
Enumeration date
07/19/2005
Last updated
09/24/2018
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