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Individual

DR. ILAVENIL WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.,

Contact information

Practice address
25805 BARTON RD STE 107, LOMA LINDA, CA 92354-3890
(909) 709-1975
Mailing address
193 N PLYMOUTH WAY, SAN BERNARDINO, CA 92408-4122
(909) 709-1975

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
A143922
CA
208600000X
Surgery Physician
A143922
CA
208D00000X
General Practice Physician
A143922
CA

Other

Enumeration date
05/13/2014
Last updated
12/06/2021
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