Healthcare Provider Details

I. General information

NPI: 1942665906
Provider Name (Legal Business Name): WFM MEDICAL AND WELLNESS CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S CENTRAL AVE SUITE 203
GLENDALE CA
91204-4370
US

IV. Provider business mailing address

550 BOWIE ST
AUSTIN TX
78703-4644
US

V. Phone/Fax

Practice location:
  • Phone: 818-844-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number7672
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number46401
License Number StateCA

VIII. Authorized Official

Name: BETSY FOSTER
Title or Position: VICE PRESIDENT
Credential:
Phone: 512-542-0420