Healthcare Provider Details

I. General information

NPI: 1740423201
Provider Name (Legal Business Name): EVELYN WILKINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 ADAMS AVE
SAN DIEGO CA
92116-2213
US

IV. Provider business mailing address

FILE #55745
LOS ANGELES CA
90074-5745
US

V. Phone/Fax

Practice location:
  • Phone: 619-284-1014
  • Fax: 619-284-4501
Mailing address:
  • Phone: 561-478-8770
  • Fax: 561-598-7231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: