Provider Demographics
NPI:1043458722
Name:WILSON, YVONNE C (YVONNE WILSON)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:C
Last Name:WILSON
Suffix:
Gender:F
Credentials:YVONNE WILSON
Other - Prefix:DR
Other - First Name:YVONNE
Other - Middle Name:C
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:P.O. BOX 1846
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-1846
Mailing Address - Country:US
Mailing Address - Phone:951-551-4675
Mailing Address - Fax:909-873-2377
Practice Address - Street 1:595 BUCKINGHAM WAY
Practice Address - Street 2:SUITE 303
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1909
Practice Address - Country:US
Practice Address - Phone:951-551-4675
Practice Address - Fax:909-873-2377
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17078103TC0700X
CAMFT26092106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1043458722Medicare PIN