Provider Demographics
NPI:1326936188
Name:WILSON, ANTIONESE M
Entity type:Individual
Prefix:
First Name:ANTIONESE
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 FORTUNA ST
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-7733
Mailing Address - Country:US
Mailing Address - Phone:562-489-6360
Mailing Address - Fax:562-489-6360
Practice Address - Street 1:1023 FORTUNA ST
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-7733
Practice Address - Country:US
Practice Address - Phone:562-489-6360
Practice Address - Fax:562-489-6360
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health