Provider Demographics
NPI:1427580240
Name:SANDRA WILSON MD INC
Entity Type:Organization
Organization Name:SANDRA WILSON MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-245-9010
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:LOS OLIVOS
Mailing Address - State:CA
Mailing Address - Zip Code:93441-0509
Mailing Address - Country:US
Mailing Address - Phone:805-245-9010
Mailing Address - Fax:805-686-9977
Practice Address - Street 1:2030 VIBORG RD
Practice Address - Street 2:
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-3219
Practice Address - Country:US
Practice Address - Phone:805-245-9010
Practice Address - Fax:805-686-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty