Healthcare Provider Details

I. General information

NPI: 1275535627
Provider Name (Legal Business Name): MYLEA N WILEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7035 N CHESTNUT AVE SUITE 105
FRESNO CA
93720-0352
US

IV. Provider business mailing address

2595 E PERRIN AVE SUITE 114
FRESNO CA
93720-5202
US

V. Phone/Fax

Practice location:
  • Phone: 559-573-7260
  • Fax: 559-573-7254
Mailing address:
  • Phone: 559-455-8944
  • Fax: 626-380-4218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA88917
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA88917
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: