Active NPI
Clarence Elwood Wilson Jr., PH.D.
- Psychologist
- Chino, CA
National Provider Identifier
1992074876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY 15219
- Practice address
- 14901 Central Ave
Chino, CA 91710-9500 - Phone
- (909) 597-1821
- NPI assigned
- Dec 21, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY 15219 | CA | Primary |
Addresses
Primary practice location
14901 Central Ave
Chino, CA 91710-9500
Mailing address
8816 Foothill Blvd Ste 103
Rancho Cucamonga, CA 91730-7199
Phone (909) 597-1821
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 15219 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1324425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324425600000",
"number": "1992074876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8816 FOOTHILL BLVD STE 103",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917307199",
"telephone_number": "909-597-1821"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14901 CENTRAL AVE",
"city": "CHINO",
"state": "CA",
"postal_code": "917109500",
"telephone_number": "909-597-1821"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CLARENCE",
"middle_name": "ELWOOD",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-12-21",
"last_updated": "2011-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY 15219",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.