Provider Demographics
NPI:1831590850
Name:WILTSHIRE, COLWYN OMANO (HOSPITAL CORPSMAN)
Entity type:Individual
Prefix:
First Name:COLWYN
Middle Name:OMANO
Last Name:WILTSHIRE
Suffix:
Gender:M
Credentials:HOSPITAL CORPSMAN
Other - Prefix:
Other - First Name:COLWYN
Other - Middle Name:OMANO
Other - Last Name:WILTSHIRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HOSPITAL CORPSMAN
Mailing Address - Street 1:140 SYLVESTER RD
Mailing Address - Street 2:BLDG 139
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-3521
Mailing Address - Country:US
Mailing Address - Phone:757-613-6755
Mailing Address - Fax:
Practice Address - Street 1:140 SYLVESTER RD
Practice Address - Street 2:BLDG 139
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-3521
Practice Address - Country:US
Practice Address - Phone:757-613-6755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman