Individual
RENALDO WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5105 W GOLDLEAF CIR, LOS ANGELES, CA 90056-1269
(323) 298-3328
Mailing address
5105 W GOLDLEAF CIR, LOS ANGELES, CA 90056-1269
(323) 298-3328
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306928254
KAISER PERMANENTE
CA
Enumeration date
04/07/2017
Last updated
04/07/2017
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