Individual
MRS. ALIX MACKENZIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
747 52ND ST, OAKLAND, CA 94609-1809
(203) 570-0111
Mailing address
2207 BRIDGEPORT WAY, MARTINEZ, CA 94553-6711
(203) 570-0111
Taxonomy
Speciality
Code
Description
License number
State
2080S0010X
Pediatric Sports Medicine Physician
55025
CA
363A00000X
Physician Assistant
PA55025
CA
363AS0400X
Surgical Physician Assistant
Primary
PA55025
CA
Other
Enumeration date
10/26/2017
Last updated
03/17/2018
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