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NPI Code Detail

MEDICARE: MATTHEW D WILSON DPM

MEDICARE: MATTHEW D WILSON DPM
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
1213E00000XPodiatristE5700CA

General Provider Information

NPI Number : 1699138891
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW D WILSON DPM
Provider Business Mailing Address
First Line : 5555 RESERVOIR DR STE 104
Second Line :
City : SAN DIEGO
State : CA
Zip : 92120-5198
Country : US
Telephone Number : 619-286-9480
Fax Number : 619-286-4568
Provider Business Practice Location Address
First Line : 5555 RESERVOIR DR STE 104
Second Line :
City : SAN DIEGO
State : CA
Zip : 92120-5198
Country : US
Telephone Number : 619-286-9480
Fax Number : 619-286-4568
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2016
Last Update Date : 03/12/2026

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Directions to “ MATTHEW D WILSON DPM” Practice Location

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