Healthcare Provider Details

I. General information

NPI: 1407055841
Provider Name (Legal Business Name): MARIA WELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N LANTANA ST
CAMARILLO CA
93010-9010
US

IV. Provider business mailing address

333 N LANTANA ST STE 259
CAMARILLO CA
93010-9008
US

V. Phone/Fax

Practice location:
  • Phone: 805-388-7740
  • Fax: 805-482-0987
Mailing address:
  • Phone: 818-746-5540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: