Provider Demographics
NPI:1609278092
Name:WILSON, MONSERRAT ALMERAZ
Entity Type:Individual
Prefix:
First Name:MONSERRAT
Middle Name:ALMERAZ
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MONSERRAT
Other - Middle Name:ALMERAZ
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:439 SAN LEON
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-8258
Mailing Address - Country:US
Mailing Address - Phone:951-285-0082
Mailing Address - Fax:
Practice Address - Street 1:439 SAN LEON
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-8258
Practice Address - Country:US
Practice Address - Phone:951-285-0082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB4560755343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)