Organization
S. GAYLE WIDYOLAR, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHEILA GAYLE WIDYOLAR M.D. (PRESIDENT)
(949) 760-2552
Entity
Organization
Contact information
Practice address
21 MONTECITO DR, CORONA DEL MAR, CA 92625-1017
(949) 760-2552
(949) 706-3808
Mailing address
21 MONTECITO DR, CORONA DEL MAR, CA 92625-1017
(949) 760-2552
(949) 706-3808
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0900X
Dermatopathology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G250560
—
CA
Enumeration date
01/22/2008
Last updated
06/20/2008
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