| Doctor Name: | DR. WILSON IZQUIERDO |
| NPI Number: | 1396998944 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 17291 |
| Business Practice Address: | 590 N Sierra Way Suite F San Bernardino, CA - 924104817 |
| Business Phone Number: | 9094953595 |
| Business Fax Number: | 9097632544 |
| Mailing Address: | 590 N Sierra Way, San Bernardino SAN BERNARDINO |
| State: | CA |
| Postal Code: | 924104817 |
| Phone Number: | 9094953595 |
| Fax Number: | 9097632544 |
| NPI Enumeration Date: | 10/28/2008 |
| NPI Last Update Date: | 10/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 17291 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |