Healthcare Provider Details

I. General information

NPI: 1942147855
Provider Name (Legal Business Name): MICHAEL M WAHOME
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 W GRAHAM AVE STE 106
LAKE ELSINORE CA
92530-3665
US

IV. Provider business mailing address

7252 ARCHIBALD AVE # 563
RANCHO CUCAMONGA CA
91701-5017
US

V. Phone/Fax

Practice location:
  • Phone: 888-638-8457
  • Fax:
Mailing address:
  • Phone: 951-710-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: