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NPI Code Detail

MEDICARE: HOPE A WILDENBERG M.D.

MEDICARE: HOPE A WILDENBERG M.D.
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
1207Q00000XFamily Medicine PhysicianG83457CO

General Provider Information

NPI Number : 1912900739
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOPE A WILDENBERG M.D.
Provider Business Mailing Address
First Line : 1081 N CHINA LAKE BLVD
Second Line :
City : RIDGECREST
State : CA
Zip : 93555-3130
Country : US
Telephone Number : 760-446-6404
Fax Number : 760-446-6415
Provider Business Practice Location Address
First Line : 105 E SYDNOR AVE STE 100
Second Line :
City : RIDGECREST
State : CA
Zip : 93555-5546
Country : US
Telephone Number : 760-446-6404
Fax Number : 760-446-6415
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 05/18/2021

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Directions to “ HOPE A WILDENBERG M.D.” Practice Location

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