Healthcare Provider Details

I. General information

NPI: 1710919782
Provider Name (Legal Business Name): YVONNE WOLNY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 N 3RD ST
LOMPOC CA
93436-7002
US

IV. Provider business mailing address

1515 E OCEAN AVE
LOMPOC CA
93436-7092
US

V. Phone/Fax

Practice location:
  • Phone: 805-736-1253
  • Fax:
Mailing address:
  • Phone: 805-737-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036106071
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA87669
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier036106071
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer
# 2
Identifier01636783
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: