Provider Demographics
NPI:1083674469
Name:WILCOX, GRACIELA (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACIELA
Middle Name:
Last Name:WILCOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 CABRILLO ST STE A1A
Mailing Address - Street 2:
Mailing Address - City:PRESIDIO OF MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93944-3201
Mailing Address - Country:US
Mailing Address - Phone:831-646-5140
Mailing Address - Fax:831-646-5344
Practice Address - Street 1:880 CASS ST STE 209
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2909
Practice Address - Country:US
Practice Address - Phone:831-646-5140
Practice Address - Fax:831-646-5344
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31480173000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI04004Medicare UPIN
AZZ125129Medicare PIN