Provider Demographics
NPI:1861604662
Name:WILSON, JAMES SANFORD (CCAPP)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:SANFORD
Last Name:WILSON
Suffix:
Gender:M
Credentials:CCAPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7348 PAINTER AVE.
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602
Mailing Address - Country:US
Mailing Address - Phone:562-236-2090
Mailing Address - Fax:562-236-2091
Practice Address - Street 1:7348 PAINTER AVE.
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602
Practice Address - Country:US
Practice Address - Phone:562-236-2090
Practice Address - Fax:562-236-2091
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII6561214225400000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No172V00000XOther Service ProvidersCommunity Health Worker