Wilson, Kelly Diane

Wilson, Kelly Diane is an individual health care provider with primary practice located at 55 Fair Dr , Costa Mesa CA 92626-6520. She recently has only one registered license in Student, Health Care / Student in an Organized Health Care Education/Training Program, which is considered as her primary health care specialty. Wilson, Kelly Diane can be contacted via phone (714) 619-6618.

Contact Information

Primary practice address
55 Fair Dr Costa Mesa CA 92626-6520
Phone: (714) 619-6618
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X

Profile Details

NPI number 1801349162
LBN Legal business name Wilson, Kelly Diane
Credentials MS, ATC
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 3rd, 2016
Last updated Aug 3rd, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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