Healthcare Provider Details

I. General information

NPI: 1568645935
Provider Name (Legal Business Name): GENERATIONS WELLNESS AND URGENT CARE APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2007
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9515 SOQUEL DR SUITE 100
APTOS CA
95003-4135
US

IV. Provider business mailing address

9515 SOQUEL DR SUITE 100
APTOS CA
95003-4135
US

V. Phone/Fax

Practice location:
  • Phone: 831-662-9355
  • Fax: 831-662-9358
Mailing address:
  • Phone: 831-662-9355
  • Fax: 831-662-9358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberC40989
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN WESLEY ELLIOTT
Title or Position: PRESIDENT AND CEO
Credential: MD, MBA
Phone: 831-662-9355