Provider Demographics
NPI:1851587919
Name:WILSON, JULIANA SUZANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:SUZANNE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7872 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1796
Mailing Address - Country:US
Mailing Address - Phone:714-527-8777
Mailing Address - Fax:714-527-8990
Practice Address - Street 1:7872 WALKER ST
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1796
Practice Address - Country:US
Practice Address - Phone:714-527-8777
Practice Address - Fax:714-527-8990
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16242363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW12122AOtherMEDICARE GROUP NUMBER
CAW12122OtherMEDICARE GROUP NUMBER
CAGR0061200Medicaid
CAGR0061190Medicaid
CAGR0061190Medicaid