Healthcare Provider Details

I. General information

NPI: 1043131162
Provider Name (Legal Business Name): WELLNESS STAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 E THORNTON AVE APT W202
HEMET CA
92543-7657
US

IV. Provider business mailing address

409 E THORNTON AVE APT W202
HEMET CA
92543-7657
US

V. Phone/Fax

Practice location:
  • Phone: 111-111-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: IKECHUKWU NWABUOBI
Title or Position: CEO
Credential:
Phone: 909-353-0117