Provider Demographics
NPI:1588636781
Name:WILSON, MARY JESS (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JESS
Last Name:WILSON
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Gender:F
Credentials:MD, MPH
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Other - First Name:
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Mailing Address - Street 1:9616 MICRON AVE
Mailing Address - Street 2:SUITE 640
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2625
Mailing Address - Country:US
Mailing Address - Phone:916-875-9900
Mailing Address - Fax:916-369-0639
Practice Address - Street 1:9616 MICRON AVE
Practice Address - Street 2:SUITE 640
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2625
Practice Address - Country:US
Practice Address - Phone:916-875-9900
Practice Address - Fax:916-369-0639
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2007-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC41404208000000X
TXG0296208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics