Provider Demographics
NPI:1124447552
Name:WILES, BRITTANY (MD)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:WILES
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 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:707-521-7777
Mailing Address - Fax:707-573-5426
Practice Address - Street 1:3883 AIRWAY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1670
Practice Address - Country:US
Practice Address - Phone:707-521-7777
Practice Address - Fax:707-573-5426
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101259157207Q00000X
CAC182428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine