Provider Demographics
NPI:1386259430
Name:WILSON, RHONDA KRISTINA (MT)
Entity type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:KRISTINA
Last Name:WILSON
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:KRISTINA
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RHONDA LANE
Mailing Address - Street 1:23678 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-9700
Mailing Address - Country:US
Mailing Address - Phone:951-392-4513
Mailing Address - Fax:
Practice Address - Street 1:28115 BRADLEY RD STE 1
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-2239
Practice Address - Country:US
Practice Address - Phone:951-392-4513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81960225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist