Basic Information
| Provider Information | |||||||||
| NPI: | 1437410966 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WYBORNY | ||||||||
| FirstName: | TESSA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 TRANCAS ST 300 | ||||||||
| Address2: | |||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074929236 | ||||||||
| FaxNumber: | 4259495377 | ||||||||
| Practice Location | |||||||||
| Address1: | 1141 PEAR TREE LN | ||||||||
| Address2: | |||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074929236 | ||||||||
| FaxNumber: | 4259495377 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2012 | ||||||||
| LastUpdateDate: | 09/25/2015 | ||||||||
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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 | 208000000X | MMD.34654 LL | SC | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | A137750 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.