Provider Demographics
NPI:1598037178
Name:WILCOX, WENONAH (LAC)
Entity type:Individual
Prefix:
First Name:WENONAH
Middle Name:
Last Name:WILCOX
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 CAMINO DEL RIO N
Mailing Address - Street 2:STE. 340
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1633
Mailing Address - Country:US
Mailing Address - Phone:619-261-8861
Mailing Address - Fax:
Practice Address - Street 1:2655 CAMINO DEL RIO N
Practice Address - Street 2:STE. 340
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1633
Practice Address - Country:US
Practice Address - Phone:619-261-8861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13675171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist