Healthcare Provider Details

I. General information

NPI: 1598085284
Provider Name (Legal Business Name): CECILE WILDIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 MIDWAY ST APT 301
SAN FRANCISCO CA
94133-2054
US

IV. Provider business mailing address

33 MIDWAY ST APT 301
SAN FRANCISCO CA
94133-2054
US

V. Phone/Fax

Practice location:
  • Phone: 415-677-4417
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number10598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: