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NPI Code Detail

MEDICARE: WISEPLACE

MEDICARE: WISEPLACE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251V00000XVoluntary or Charitable Agency

General Provider Information

NPI Number : 1437876968
Entity Type Code : Organization
Provider Name (Legal Business Name) : WISEPLACE
Provider Business Mailing Address
First Line : 1411 N BROADWAY
Second Line :
City : SANTA ANA
State : CA
Zip : 92706-3904
Country : US
Telephone Number : 714-542-3577
Fax Number :
Provider Business Practice Location Address
First Line : 1411 N BROADWAY
Second Line :
City : SANTA ANA
State : CA
Zip : 92706-3904
Country : US
Telephone Number : 714-542-3577
Fax Number :
Authorized Official
Title or Position : CEO
Name : BRATEIL AGHASI
Credential :
Telephone Number : 714-542-3577
Provider Enumeration Date : 10/25/2022
Last Update Date : 10/25/2022

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Directions to “WISEPLACE ” Practice Location

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