Healthcare Provider Details

I. General information

NPI: 1831804657
Provider Name (Legal Business Name): WP ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11860 CONFLUENCE DR
JURUPA VALLEY CA
91752-9269
US

IV. Provider business mailing address

6305 NOBURY CT
EASTVALE CA
92880-0751
US

V. Phone/Fax

Practice location:
  • Phone: 657-722-9269
  • Fax:
Mailing address:
  • Phone: 657-722-7259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: PATSARA CHANTHARASETH
Title or Position: LICENSEE
Credential:
Phone: 657-722-9269