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NPI Code Detail

MEDICARE: RITA WILSON

MEDICARE: RITA 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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1891913570
Entity Type Code : Individual
Provider Name (Legal Business Name) : RITA WILSON
Provider Business Mailing Address
First Line : 14604 GAULT ST
Second Line : APT. 13
City : VAN NUYS
State : CA
Zip : 91405-3011
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5220 W WASHINGTON BLVD
Second Line : SUITE 101
City : LOS ANGELES
State : CA
Zip : 90016-1331
Country : US
Telephone Number : 323-933-9186
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2007
Last Update Date : 07/08/2007

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Directions to “ RITA WILSON ” Practice Location

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