Healthcare Provider Details

I. General information

NPI: 1922790906
Provider Name (Legal Business Name): WHOLE PERSON CARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N ASH ST
ESCONDIDO CA
92027-3058
US

IV. Provider business mailing address

120 N ASH ST
ESCONDIDO CA
92027-3058
US

V. Phone/Fax

Practice location:
  • Phone: 760-385-3739
  • Fax: 888-800-8226
Mailing address:
  • Phone: 760-385-3739
  • Fax: 888-800-8226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1000X
TaxonomyMigrant Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY LELIA BAKER
Title or Position: EXECUTIVE DIRECTOR
Credential: FNP
Phone: 760-385-3739