Healthcare Provider Details

I. General information

NPI: 1902498611
Provider Name (Legal Business Name): SYLVIA K WILSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E CHURCH ST STE 202
SANTA MARIA CA
93454-5915
US

IV. Provider business mailing address

1325 E CHURCH ST STE 202
SANTA MARIA CA
93454-5915
US

V. Phone/Fax

Practice location:
  • Phone: 805-346-3456
  • Fax: 805-346-3454
Mailing address:
  • Phone: 805-346-3456
  • Fax: 805-346-3454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA1124802
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number67804
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: