Millicent Elaine Wilson, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

G079177 Issued in CA

Practice address

245 S Fetterly Ave
East Los Angeles, CA 90022-1605

Phone

(323) 362-1400

Fax

(323) 362-1373

NPI assigned

Jan 16, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516060800000",
    "number": "1558879296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10100 PIONEER BLVD STE 200",
            "city": "SANTA FE SPRINGS",
            "state": "CA",
            "postal_code": "906708299",
            "telephone_number": "562-347-1648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 S FETTERLY AVE",
            "city": "EAST LOS ANGELES",
            "state": "CA",
            "postal_code": "900221605",
            "telephone_number": "323-362-1400",
            "fax_number": "323-362-1373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MILLICENT",
        "middle_name": "ELAINE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-16",
        "last_updated": "2018-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G079177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cindy Joana Tapia-Mendoza
• Valeria Del Rocio Temblador
• Dao Tien Truong
• Gisela Valenzuela
• Anthony Ray Wallace
• Xochitlquetzal Birthwork LLC
• Ericson Yabut
• Gissel Yam Ciau, MA
• Timothy Young, REGISTERED NURSE
• Curtis Yu

• Emergency Medicine Physician in East Los Angeles, CA
• Providers in East Los Angeles, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.