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NPI Code Detail

MEDICARE: LISA WILSON

MEDICARE: LISA WILSON
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
1171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14763OTHERCACOUNTY ID

General Provider Information

NPI Number : 1487727418
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA WILSON
Provider Business Mailing Address
First Line : 499 LOMA ALTA AVE
Second Line :
City : LOS GATOS
State : CA
Zip : 95030-6227
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 499 LOMA ALTA AVE
Second Line :
City : LOS GATOS
State : CA
Zip : 95030-6227
Country : US
Telephone Number : 408-335-1909
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2006
Last Update Date : 07/08/2007

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Directions to “ LISA WILSON ” Practice Location

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