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NPI Code Detail

MEDICARE: MRS. BRENDA L WILKINSON MFT

MEDICARE: MRS. BRENDA L WILKINSON MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist40435CA

General Provider Information

NPI Number : 1083725030
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BRENDA L WILKINSON MFT
Provider Business Mailing Address
First Line : 4909 MURPHY CANYON RD STE 300
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-4301
Country : US
Telephone Number : 858-268-9800
Fax Number : 858-268-9810
Provider Business Practice Location Address
First Line : 4909 MURPHY CANYON RD STE 300
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-4301
Country : US
Telephone Number : 858-268-9800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 09/24/2024

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