| Mylea N Wiley Md Inc. | |
|
2755 Herndon Ave Clovis CA 93611-6801 | |
| (559) 324-4000 | |
| (559) 324-3744 |
| Full Name | Mylea N Wiley Md Inc. |
|---|---|
| Speciality | Hospitalist |
| Location | 2755 Herndon Ave, Clovis, California |
| Authorized Official Name and Position | Mylea N Wiley (OWNER/PHYSICIAN) |
| Authorized Official Contact | 5132373242 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mylea N Wiley Md Inc. 2595 E Perrin Ave #114 Fresno CA 93720-5202 Ph: (559) 455-8944 | Mylea N Wiley Md Inc. 2755 Herndon Ave Clovis CA 93611-6801 Ph: (559) 324-4000 |
| NPI Number | 1760012959 |
|---|---|
| Provider Enumeration Date | 01/16/2020 |
| Last Update Date | 07/18/2024 |
| Medicare PECOS PAC ID | 7214361989 |
|---|---|
| Medicare Enrollment ID | O20200619000123 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760012959 | NPI | - | NPPES |
| 00A889170 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208M00000X | Hospitalist | (* (Not Available)) | Primary |
| Provider Name | Mylea N Wiley |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1275535627 PECOS PAC ID: 7012947096 Enrollment ID: I20050818001027 |
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