Provider Demographics
NPI:1578929113
Name:ABRAHAM WILSON INC
Entity Type:Organization
Organization Name:ABRAHAM WILSON INC
Other - Org Name:JACARANDA COMMUNITY URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-956-2636
Mailing Address - Street 1:12021 JACARANDA AVE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-4978
Mailing Address - Country:US
Mailing Address - Phone:760-956-2636
Mailing Address - Fax:760-948-2179
Practice Address - Street 1:12021 JACARANDA AVE
Practice Address - Street 2:SUITE #100
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-4978
Practice Address - Country:US
Practice Address - Phone:760-956-2636
Practice Address - Fax:760-948-2179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66379261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care