Healthcare Provider Details

I. General information

NPI: 1578416624
Provider Name (Legal Business Name): GARY JOSEPH WYER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9532 GROSSMONT BLVD
LA MESA CA
91941-4150
US

IV. Provider business mailing address

9532 GROSSMONT BLVD
LA MESA CA
91941-4150
US

V. Phone/Fax

Practice location:
  • Phone: 619-727-0112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95040975
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number849318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: