Provider Demographics
NPI:1538358387
Name:WILSON, JON S (CPO)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:S
Last Name:WILSON
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E ROMIE LN STE 3
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4026
Mailing Address - Country:US
Mailing Address - Phone:831-422-9646
Mailing Address - Fax:
Practice Address - Street 1:535 E ROMIE LN STE 3
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4026
Practice Address - Country:US
Practice Address - Phone:831-422-9646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist