Healthcare Provider Details

I. General information

NPI: 1194380303
Provider Name (Legal Business Name): PEAR WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1452 26TH ST STE 108
SANTA MONICA CA
90404-3085
US

IV. Provider business mailing address

8995 KEITH AVE APT 4
WEST HOLLYWOOD CA
90069-4919
US

V. Phone/Fax

Practice location:
  • Phone: 310-570-9063
  • Fax:
Mailing address:
  • Phone: 310-570-9063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number87029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: