Healthcare Provider Details

I. General information

NPI: 1780914093
Provider Name (Legal Business Name): TOSCA LIEN WILSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. TOSCA LIEN WILSON-DAVIS

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 01/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 FULTON AVE SUITE 205
SACRAMENTO CA
95825-4500
US

IV. Provider business mailing address

65 DEROW CT
SACRAMENTO CA
95833-1919
US

V. Phone/Fax

Practice location:
  • Phone: 916-393-1222
  • Fax: 916-484-3570
Mailing address:
  • Phone: 916-568-6482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: