MEDICARE: SANDRA CATHERINE WILSON MD

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	207R00000X	Internal Medicine Physician	G80126	CA

General Provider Information

NPI Number	:	1457440638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA CATHERINE WILSON MD

Provider Business Mailing Address
First Line	:	POST OFFICE BOX 509
Second Line	:
City	:	LOS OLIVOS
State	:	CA
Zip	:	93441
Country	:	US
Telephone Number	:	805-245-9010
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 VIBORG RD STE 110
Second Line	:
City	:	SOLVANG
State	:	CA
Zip	:	93463-3225
Country	:	US
Telephone Number	:	805-691-9712
Fax Number	:	805-693-2298

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	03/15/2024

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