Most Relevant Information
Provider Data
| NPI Number: | 1003688946 |
| Provider Name: | ORLANDO TERRELL WIGGINS RADT |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/24/2023 |
| Last Updated: | 10/24/2023 |
Provider Practice Location
603 D ST
SAN RAFAEL
CA
949013719
Practice Location Phone/Fax
| Phone: | 4154924444 |
| Fax: |
Provider Mailing Location
603 D ST
SAN RAFAEL
CA
949013719
Provider Mailing Phone/Fax
| Phone: | 4157246895 |
| Fax: |