Provider Demographics
NPI:1649541665
Name:WILHOVSKY, PETER NONE JR
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:NONE
Last Name:WILHOVSKY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:NONE
Other - Last Name:WILHOVSKY
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:14901 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-9500
Mailing Address - Country:US
Mailing Address - Phone:909-597-1821
Mailing Address - Fax:909-606-7106
Practice Address - Street 1:14901 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-9500
Practice Address - Country:US
Practice Address - Phone:909-597-1821
Practice Address - Fax:909-606-7106
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16137103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical