1841557907 NPI number — THE WAY TO WELLNESS CENTER

Table of content: (NPI 1841557907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841557907 NPI number — THE WAY TO WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE WAY TO WELLNESS CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841557907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23141 VERDUGO DRIVE
Provider Second Line Business Mailing Address:
104
Provider Business Mailing Address City Name:
LAGUNA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92653-1341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-305-9777
Provider Business Mailing Address Fax Number:
949-955-2699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23141 VERDUGO DRIVE
Provider Second Line Business Practice Location Address:
104
Provider Business Practice Location Address City Name:
LAGUNA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92653-1341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-305-9777
Provider Business Practice Location Address Fax Number:
949-955-2699
Provider Enumeration Date:
04/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
NASSERNIA
Authorized Official First Name:
MAHNAZ
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
949-955-2655

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC4591 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AC4591 . This is a "N/A" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com