Basic Information
| Provider Information | |||||||||
| NPI: | 1083850838 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIBERG | ||||||||
| FirstName: | MARGARETA | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | X | ||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1030 E ELIZABETH ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937283523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594863848 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 23370 ROAD 22 | ||||||||
| Address2: | |||||||||
| City: | CHOWCHILLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936108504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596655531 | ||||||||
| FaxNumber: | 5596656040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2008 | ||||||||
| LastUpdateDate: | 12/29/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY17100 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.