Healthcare Provider Details

I. General information

NPI: 1659404705
Provider Name (Legal Business Name): JAMES FRANK WILSON C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 WEST CARSON STREET
TORRANCE CA
90501-3909
US

IV. Provider business mailing address

1319 WEST CARSON STREET
TORRANCE CA
90501-3909
US

V. Phone/Fax

Practice location:
  • Phone: 310-320-5777
  • Fax: 310-320-6341
Mailing address:
  • Phone: 310-320-5777
  • Fax: 310-320-6341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1583
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCO001583
License Number State
# 3
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCO001583
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: