S. Gayle Widyolar, M.D., Inc.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

S. GAYLE WIDYOLAR, M.D., INC.

Practice address

21 Montecito Dr
Corona del Mar, CA 92625-1017

Phone

(949) 760-2552

Fax

(949) 706-3808

NPI assigned

Jan 22, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Sheila Gayle Widyolar, M.D.

Title

President

Phone

(949) 760-2552

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1200960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213920000000",
    "number": "1457538415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 MONTECITO DR",
            "city": "CORONA DEL MAR",
            "state": "CA",
            "postal_code": "926251017",
            "telephone_number": "949-760-2552",
            "fax_number": "949-706-3808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 MONTECITO DR",
            "city": "CORONA DEL MAR",
            "state": "CA",
            "postal_code": "926251017",
            "telephone_number": "949-760-2552",
            "fax_number": "949-706-3808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S. GAYLE WIDYOLAR, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-22",
        "last_updated": "2008-06-20",
        "status": "A",
        "authorized_official_last_name": "WIDYOLAR",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_middle_name": "GAYLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-760-2552",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G250560",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aimee Johanna Rodriguez, APRN, FNP-C
• Rokhsareh Tajrishi Inc.
• Roya Khodaie, MD Inc.
• Ana Rosalia Rubiolo, DDS
• Janelle Alyce Ruh
• George F. Saliba, DDS
• James Jude Sanders, LMFT
• Chelsea Sermak, FNP-C
• Bert Shepley
• Meera Misra Shukla, M.D.

• Dermatology Physician in Corona del Mar, CA
• Providers in Corona del Mar, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2008; 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.