Individual
JULIANA SUZANNE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7872 WALKER ST, LA PALMA, CA 90623-1796
(714) 527-8777
(714) 527-8990
Mailing address
7872 WALKER ST, LA PALMA, CA 90623-1796
(714) 527-8777
(714) 527-8990
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA16242
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0061190
—
CA
05
—
GR0061200
—
CA
01
—
W12122
MEDICARE GROUP NUMBER
CA
01
—
W12122A
MEDICARE GROUP NUMBER
CA
Enumeration date
09/21/2007
Last updated
03/07/2023
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