Organization
S. GAYLE WIDYOLAR, M.D., INC.
Active
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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