Individual
SEAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPT
Contact information
Practice address
1160 S GRAND AVE, GLENDORA, CA 91740-5000
(626) 335-5980
Mailing address
9160 HAMILTON ST, RANCHO CUCAMONGA, CA 91701-4894
(909) 561-5215
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT41616
CA
Other
Enumeration date
08/09/2021
Last updated
08/09/2021
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