Provider Demographics
NPI:1629177449
Name:WIESLANDER, CECILIA KARIN (MD)
Entity type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:KARIN
Last Name:WIESLANDER
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:14445 OLIVE VIEW DR RM 6D112
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-1438
Mailing Address - Country:US
Mailing Address - Phone:477-210-3222
Mailing Address - Fax:477-210-3255
Practice Address - Street 1:14445 OLIVE VIEW DR # 6D112
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1438
Practice Address - Country:US
Practice Address - Phone:747-210-3222
Practice Address - Fax:747-210-3255
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9551207V00000X
CAA78497207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167285901Medicaid
I10375Medicare UPIN