Provider Demographics
NPI:1841383858
Name:WILSON, MARCELLA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCELLA
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3131 CAMINO DEL RIO NORTH
Mailing Address - Street 2:270
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:619-282-7172
Mailing Address - Fax:619-282-7626
Practice Address - Street 1:3131 CAMINO DEL RIO NORTH
Practice Address - Street 2:270
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-282-7172
Practice Address - Fax:619-282-7626
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG0592752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG59275Medicare ID - Type Unspecified