Provider Demographics
NPI:1063514115
Name:WILSON, ROCHELLE L (DO)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:L
Last Name:WILSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1202 MARICOPA HWY
Mailing Address - Street 2:STE C
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3129
Mailing Address - Country:US
Mailing Address - Phone:805-640-0068
Mailing Address - Fax:805-640-1749
Practice Address - Street 1:1202 MARICOPA HWY
Practice Address - Street 2:STE C
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3129
Practice Address - Country:US
Practice Address - Phone:805-640-0068
Practice Address - Fax:805-640-1749
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A5012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
W20A5012EMedicare ID - Type Unspecified
E17540Medicare UPIN