Provider Demographics
NPI:1174527105
Name:WIDYOLAR, SHEILA GAYLE (MD)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:GAYLE
Last Name:WIDYOLAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23961 CALLE DE MAGDALENA
Mailing Address - Street 2:SUITE 403
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23961 CALLE DE MAGDALENA
Practice Address - Street 2:SUITE 403
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3664
Practice Address - Country:US
Practice Address - Phone:949-452-3814
Practice Address - Fax:949-855-1007
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25056207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G250560Medicaid
CA00G250560Medicaid
A42501Medicare UPIN