Individual provider Active NPI

Sheila Gayle Widyolar, MD

  • Dermatology Physician
  • Laguna Hills, CA
National Provider Identifier
1174527105
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
G25056 Issued in CA
Practice address
23961 Calle de Magdalena
Suite 403
Laguna Hills, CA 92653-3664
Phone
(949) 452-3814
Fax
(949) 855-1007
NPI assigned
Jun 8, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X G25056 CA Primary

Addresses

Primary practice location

23961 Calle de Magdalena
Suite 403
Laguna Hills, CA 92653-3664

Mailing address

23961 Calle de Magdalena
Suite 403
Laguna Hills, CA 92653-3664

Other identifiers 1

IdentifierTypeStateIssuer
00G250560MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G25056CAMDDermatology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1174527105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23961 CALLE DE MAGDALENA",
            "address_2": "SUITE 403",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926533664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23961 CALLE DE MAGDALENA",
            "address_2": "SUITE 403",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926533664",
            "telephone_number": "949-452-3814",
            "fax_number": "949-855-1007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDYOLAR",
        "first_name": "SHEILA",
        "middle_name": "GAYLE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-08",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G25056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G250560",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laguna Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.