Provider Demographics
NPI:1568000339
Name:WILSON DOBY, WENDA RENEE
Entity Type:Individual
Prefix:MRS
First Name:WENDA
Middle Name:RENEE
Last Name:WILSON DOBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 GLOW POINTE
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582
Mailing Address - Country:US
Mailing Address - Phone:951-488-4666
Mailing Address - Fax:951-350-8284
Practice Address - Street 1:1903 GLOW POINTE
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582
Practice Address - Country:US
Practice Address - Phone:951-488-4666
Practice Address - Fax:951-350-8284
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372500000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No372500000XNursing Service Related ProvidersChore Provider