Provider Demographics
NPI:1841465556
Name:WIGFALL, DONNELL (DO)
Entity type:Individual
Prefix:
First Name:DONNELL
Middle Name:
Last Name:WIGFALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1233 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3819
Mailing Address - Country:US
Mailing Address - Phone:909-762-6625
Mailing Address - Fax:
Practice Address - Street 1:12625 HESPERIA RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7720
Practice Address - Country:US
Practice Address - Phone:760-995-8300
Practice Address - Fax:760-955-2356
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A116252084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry