Individual
DR. LISA MARIE WIELER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1100 MONTEREY ST, SUITE 210, SAN LUIS OBISPO, CA 93401-3102
(805) 542-9700
(805) 542-0584
Mailing address
1100 MONTEREY ST, SUITE 210, SAN LUIS OBISPO, CA 93401-3102
(805) 542-9700
(805) 542-0584
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G46986
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G19230
—
CA
01
—
CH9716
CHAMPUS
CA
01
—
G46986
LICENSE
CA
01
—
P00138584
RAILROAD MEDICARE
CA
Enumeration date
11/17/2006
Last updated
07/08/2007
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