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General NPI Number Information
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NPI Number | 1104186899
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Entity Type | Individual
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Provider Name | RYAN M WILKE D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/29/2012
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 11878 AVENUE OF INDUSTRY
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City | SAN DIEGO
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State | CA
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Zip | 92128-3423
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Country | US
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Telephone | 760-317-5797
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Fax | 858-788-0071
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Provider Business Mailing Address
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Address Line | PO BOX 1770
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City | LA MESA
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State | CA
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Zip | 91944-1770
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Country | US
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Telephone | 760-317-5797
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 20A13131
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | R2153
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License Number State | AZ
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