Healthcare Provider Details

I. General information

NPI: 1669304465
Provider Name (Legal Business Name): JULIET WISEMAN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28693 OLD TOWN FRONT ST STE 300
TEMECULA CA
92590-2789
US

IV. Provider business mailing address

28693 OLD TOWN FRONT ST STE 300
TEMECULA CA
92590-2789
US

V. Phone/Fax

Practice location:
  • Phone: 951-249-3426
  • Fax: 951-346-3458
Mailing address:
  • Phone: 951-249-3426
  • Fax: 951-346-3458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number22631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: