MEDICARE: STARCHILD WEIVODA DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	02004645A	IN
2	207Q00000X	Family Medicine Physician	18475	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245506195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STARCHILD WEIVODA DO

Provider Business Mailing Address
First Line	:	2050 S BLOSSER RD
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93458-7310
Country	:	US
Telephone Number	:	805-361-8030
Fax Number	:	805-361-8097

Provider Business Practice Location Address
First Line	:	4711 HIGHWAY 166
Second Line	:
City	:	NEW CUYAMA
State	:	CA
Zip	:	93254
Country	:	US
Telephone Number	:	661-766-2149
Fax Number	:	661-766-2350

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2012
Last Update Date	:	10/15/2020

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Directions to “ STARCHILD WEIVODA DO” Practice Location

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