Wilson Medical Group, PC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

WILSON MEDICAL GROUP, PC

Doing business as

South Bay Behavioral Medicine

Practice address

4305 Torrance Blvd Ste 508
Torrance, CA 90503-4493

Phone

(424) 392-6060

Fax

(424) 392-6062

NPI assigned

Jan 23, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Cara Wilson, MDNPI 1356751879

Title

President

Phone

(424) 392-6060

Specialties & licenses 3

Addresses

Other names 1

• South Bay Behavioral Medicine Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cara Meghan Wilson, M.D.

  • Internal Medicine Physician
  • Torrance, CA
  • NPI 1356751879
  NPD Authorized official

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

{
    "created_epoch": "1579737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579737600000",
    "number": "1790315141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 CULVER BLVD STE 171",
            "city": "PLAYA DEL REY",
            "state": "CA",
            "postal_code": "902937704",
            "telephone_number": "424-392-6060",
            "fax_number": "424-392-6062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4305 TORRANCE BLVD STE 508",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905034493",
            "telephone_number": "424-392-6060",
            "fax_number": "424-392-6062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON MEDICAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-23",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "CARA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "424-392-6060",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Bay Behavioral Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Areulius Damond Willis
• Hunter Faith Willis
• Randee Denice Willis, PA-C
• Stacey Willis
• Therese Judith Willis, DPT
• Angela Michelle Wilson
• Cara Meghan Wilson, M.D.
• Courtney Reece Wilson, CF-SLP
• Davon Wilson
• Edward John Wilson, MD

• Multi-Specialty Clinic/Center in Torrance, CA
• Providers in Torrance, CA by specialty
• Multi-Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2020; 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.