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General NPI Number Information
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NPI Number | 1710875372
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Entity Type | Individual
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Provider Name | JULIA WILSON PA
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Gender | Female
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Dates
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Enumeration Date | 06/24/2025
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 595 E COLORADO BLVD STE 629
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City | PASADENA
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State | CA
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Zip | 91101-5222
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Country | US
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Telephone | 626-219-2533
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Fax |
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Provider Business Mailing Address
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Address Line | 260 N OAKLAND AVE APT 10
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City | PASADENA
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State | CA
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Zip | 91101-1645
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Country | US
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Telephone | 717-575-6102
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0814X
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Taxonomy Name | Psychoanalysis Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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