Healthcare Provider Details

I. General information

NPI: 1710875372
Provider Name (Legal Business Name): JULIA WILSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 E COLORADO BLVD STE 629
PASADENA CA
91101-5222
US

IV. Provider business mailing address

260 N OAKLAND AVE APT 10
PASADENA CA
91101-1645
US

V. Phone/Fax

Practice location:
  • Phone: 626-219-2533
  • Fax:
Mailing address:
  • Phone: 717-575-6102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: