Healthcare Provider Details

I. General information

NPI: 1619817384
Provider Name (Legal Business Name): W. DWAYNE MCELWEE CMPSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: WILLIE DWAYNE MCELWEE CMPSS

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24328 VERMONT AVE STE 316
HARBOR CITY CA
90710-2320
US

IV. Provider business mailing address

24328 VERMONT AVE STE 316
HARBOR CITY CA
90710-2320
US

V. Phone/Fax

Practice location:
  • Phone: 866-798-1118
  • Fax: 866-794-4232
Mailing address:
  • Phone: 866-798-1118
  • Fax: 866-794-4232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-HZKEML
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: