Provider Demographics
NPI:1376694802
Name:WOOTEN, WILMA JEAN (MD)
Entity Type:Individual
Prefix:
First Name:WILMA
Middle Name:JEAN
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1700 PACIFIC HWY STE 311
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2417
Mailing Address - Country:US
Mailing Address - Phone:619-515-6519
Mailing Address - Fax:619-515-6527
Practice Address - Street 1:1700 PACIFIC HWY STE 311
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2417
Practice Address - Country:US
Practice Address - Phone:619-515-6519
Practice Address - Fax:619-515-6527
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA464742083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine