Healthcare Provider Details

I. General information

NPI: 1790691152
Provider Name (Legal Business Name): MR. JAMES BERNARD WANDRIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 45TH ST
JURUPA VALLEY CA
92509-7201
US

IV. Provider business mailing address

4040 BRISTLECONE PINE LN
SAN BERNARDINO CA
92407-9048
US

V. Phone/Fax

Practice location:
  • Phone: 951-222-7877
  • Fax:
Mailing address:
  • Phone: 951-222-7877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: