Provider Demographics
NPI:1659404705
Name:WILSON, JAMES FRANK (CO)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:FRANK
Last Name:WILSON
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1319 WEST CARSON STREET
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3909
Mailing Address - Country:US
Mailing Address - Phone:310-320-5777
Mailing Address - Fax:310-320-6341
Practice Address - Street 1:1319 WEST CARSON STREET
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3909
Practice Address - Country:US
Practice Address - Phone:310-320-5777
Practice Address - Fax:310-320-6341
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1583174400000X
CO001583174400000X, 222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No174400000XOther Service ProvidersSpecialist