Individual provider Active NPI

Theresa Wilson

  • Family Nurse Practitioner
  • San Clemente, CA
National Provider Identifier
1760631592
Registry record updated Nov 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
8242 Issued in CA
Practice address
724 S El Camino Real
San Clemente, CA 92672-4250
Phone
(949) 493-6113
Fax
(949) 493-5851
NPI assigned
Sep 17, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 8242 CA Primary

Addresses

Primary practice location

724 S El Camino Real
San Clemente, CA 92672-4250

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 579-3203

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090709000400 CA Practitioner - Nurse Practitioner 2769534536 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Centers for Family Medicine GPGroup PAC ID 9931143799, 87 clinicians

Practice addresses (Care Compare)

3460 Katella Ave
Los Alamitos, CA 90720-2334
Phone (562) 594-6599

724 S El Camino Real
San Clemente, CA 92672-4250
Phone (949) 493-6113

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
8242CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Centers for Family Medicine GP CurrentSince Apr 27, 2015 Accepting new patients
Healthcare Partners Affiliates Medical Group CurrentSince Jul 1, 2025 Accepting new patients
Healthcare Partners Affiliates Medical Group CurrentSince Jul 1, 2025 Accepting new patients

Locations

1236 N Magnolia Ave
Anaheim, CA 92801
Phone (714) 995-1000

5957 W Ramsey St
Banning, CA 92220
Phone (951) 845-8864

2910 Jefferson St
Ste 100
Carlsbad, CA 92008
Phone (760) 729-8600

824 E Carson St
Ste 104
Carson, CA 90745
Phone (310) 830-9706

11 Technology Dr
Irvine, CA 92618
Phone (855) 206-6764

3460 Katella Ave
Los Alamitos, CA 90720
Phone (310) 594-6599

724 S El Camino Real
San Clemente, CA 92672
Phone (949) 453-4343

1700 N Waterman Ave
Sn Bernrdno, CA 92404
Phone (909) 883-8611

Interoperability endpoints

  • Direct secure messaging: theresa.wilson.p7@direct.monarchhealthcare.nextgenshare.com
  • Direct secure messaging: theresa.wilson.p33@direct.monarchhealthcare.nextgenshare.com
  • Direct secure messaging: twilson195454@westdirect.optum.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1221609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764460800000",
    "number": "1760631592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-579-3203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "724 S EL CAMINO REAL",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926724250",
            "telephone_number": "949-493-6113",
            "fax_number": "949-493-5851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "THERESA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-17",
        "last_updated": "2025-11-30",
        "certification_date": "2025-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "8242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Clemente, CA

Sources for this page

Verify at the official NPI Registry.