Healthcare Provider Details

I. General information

NPI: 1073861605
Provider Name (Legal Business Name): PROHEALTH WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10141 WESTMINSTER AVE #204
GARDEN GROVE CA
92843
US

IV. Provider business mailing address

10141 WESTMINSTER AVE #204
GARDEN GROVE CA
92843
US

V. Phone/Fax

Practice location:
  • Phone: 714-590-9872
  • Fax: 714-590-2232
Mailing address:
  • Phone: 714-590-9872
  • Fax: 714-590-2232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberDC30705
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC31805
License Number StateCA

VIII. Authorized Official

Name: DR. ANNE V NGUYEN
Title or Position: PRESIDENT/ OWNER
Credential: D.C.
Phone: 818-450-7351