Healthcare Provider Details

I. General information

NPI: 1336205376
Provider Name (Legal Business Name): GLOBAL WELLNESS MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26740 TOWNE CENTRE DRIVE
FOOTHILL RANCH CA
92610
US

IV. Provider business mailing address

26740 TOWNE CENTRE DRIVE
FOOTHILL RANCH CA
92610
US

V. Phone/Fax

Practice location:
  • Phone: 949-588-9293
  • Fax: 949-588-0409
Mailing address:
  • Phone: 949-588-9293
  • Fax: 949-588-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA045267
License Number StateCA

VIII. Authorized Official

Name: DR. BAKUL KUMAR PATEL
Title or Position: OWNER
Credential: MD
Phone: 949-588-9293