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NPI Code Detail

MEDICARE: MAYOLA GABRIEL WIPF

MEDICARE: MAYOLA GABRIEL WIPF
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1247200000XOther Technician
2101YA0400XAddiction (Substance Use Disorder) CounselorR1576410824CA

General Provider Information

NPI Number : 1891302733
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAYOLA GABRIEL WIPF
Provider Business Mailing Address
First Line : 336 OXFORD ST STE 209
Second Line :
City : CHULA VISTA
State : CA
Zip : 91911-3122
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 336 OXFORD ST STE 209
Second Line :
City : CHULA VISTA
State : CA
Zip : 91911-3122
Country : US
Telephone Number : 619-691-1662
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2020
Last Update Date : 02/03/2025

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Directions to “ MAYOLA GABRIEL WIPF ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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