Healthcare Provider Details

I. General information

NPI: 1184703167
Provider Name (Legal Business Name): JOHN STEWART WELLS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E LIVE OAK AVE
ARCADIA CA
91006-5617
US

IV. Provider business mailing address

330 E LIVE OAK AVE
ARCADIA CA
91006-5617
US

V. Phone/Fax

Practice location:
  • Phone: 626-821-5858
  • Fax: 626-821-0858
Mailing address:
  • Phone: 626-821-5858
  • Fax: 626-821-0858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG12298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: