Healthcare Provider Details

I. General information

NPI: 1538373683
Provider Name (Legal Business Name): HEALTHXL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CARAWAY
IRVINE CA
92604-3211
US

IV. Provider business mailing address

8 CARAWAY
IRVINE CA
92604-3211
US

V. Phone/Fax

Practice location:
  • Phone: 949-653-1233
  • Fax: 949-653-1233
Mailing address:
  • Phone: 949-653-1233
  • Fax: 949-653-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number16161
License Number StateCA

VIII. Authorized Official

Name: DR. CAROL WINTERMUTE
Title or Position: PRESIDENT
Credential: DC
Phone: 949-653-1233