Individual provider · Type 1 NPI

Taylor Kettle Wilson, PA-C

Student in an Organized Health Care Education/Training Program · Rancho Cucamonga, CA

NPI number 1710573134 Active

Practice location

10601 Church St 105
Rancho Cucamonga, CA 91730

Call (909) 989-7100 Map

Fax (909) 989-6333

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1710573134

Taylor Kettle Wilson, PA-C's National Provider Identifier is 1710573134, issued on Dec 19, 2020. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Rancho Cucamonga, CA. The record was last updated on Oct 31, 2024.