Healthcare Provider Details

I. General information

NPI: 1104684612
Provider Name (Legal Business Name): PEDIATRIC WELLNESS PARTNERS, A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

974 RALSTON AVE STE 4
BELMONT CA
94002-2249
US

IV. Provider business mailing address

974 RALSTON AVE STE 4
BELMONT CA
94002-2249
US

V. Phone/Fax

Practice location:
  • Phone: 650-910-4708
  • Fax: 650-412-7648
Mailing address:
  • Phone: 650-910-4708
  • Fax: 650-412-7648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY J. ERLICH
Title or Position: FOUNDER/NURSE PRACTITIONER
Credential: NP
Phone: 650-910-4708