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General NPI Number Information
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NPI Number | 1316011083
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Entity Type | Individual
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Provider Name | LISA MARIE WIELER M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1100 MONTEREY ST SUITE 210
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-3102
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Country | US
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Telephone | 805-542-9700
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Fax | 805-542-0584
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Provider Business Mailing Address
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Address Line | 1100 MONTEREY ST SUITE 210
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-3102
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Country | US
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Telephone | 805-542-9700
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Fax | 805-542-0584
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G46986
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License Number State | CA
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