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General NPI Number Information
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NPI Number | 1053417725
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Entity Type | Organization
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Legal Business Name | GARY WIKHOLM M D A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 247 W HARVARD BLVD
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City | SANTA PAULA
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State | CA
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Zip | 93060-3223
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Country | US
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Telephone | 805-525-0907
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Fax | 805-933-3392
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Provider Business Mailing Address
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Address Line | 247 W HARVARD BLVD
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City | SANTA PAULA
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State | CA
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Zip | 93060-3223
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Country | US
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Telephone | 805-525-0907
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Fax | 805-933-3392
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Authorized Official
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Title or Position | MANAGER
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Name | MS. AGI KESSLER
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Credential |
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Telephone | 805-525-0907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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