Provider Demographics
NPI:1427858182
Name:WILSON, JOHN BRANT
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:BRANT
Last Name:WILSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9175 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3648
Mailing Address - Country:US
Mailing Address - Phone:805-205-3604
Mailing Address - Fax:
Practice Address - Street 1:9175 3RD AVE
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3648
Practice Address - Country:US
Practice Address - Phone:805-205-3604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker