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Juanita Wilson

NPI Registration Record

Provider / OrganizationNPIDate Certified
JUANITA WILSON18519186272020-06-28
Entity TypeIndividual
Provider NameMrs. Juanita Wilson
Practice Office Address23461 S POINTE DR
LAGUNA HILLS, CA US
Practice Office Telephone9493301683
Mailing Address3590 BRENTRIDGE DR
CORONA, CA 928818443 US
Business Telephone7148014915
HPT Codes
CodeLicense NoState
390200000X PRIMARY
193400000X MULTGroup Code
OPI Codes

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