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Ebonique Wilson
NPI 1770181521 · on the registry since 2020 · sole proprietor
Practice
- Address
- 380 Vista Roma Way Unit 316
San Jose, CA 95136 - Phone
- (408) 603-7012
Registry record
- Primary taxonomy
- 225700000X
225700000X
- Licence states on file
- CA
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2020-10-14
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California