Healthcare Provider Details

I. General information

NPI: 1700343613
Provider Name (Legal Business Name): DONALD ANDREW WELLS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 LONG BEACH BLVD
LONG BEACH CA
90807-5062
US

IV. Provider business mailing address

3210 LONG BEACH BLVD
LONG BEACH CA
90807-5062
US

V. Phone/Fax

Practice location:
  • Phone: 562-548-6500
  • Fax:
Mailing address:
  • Phone: 562-548-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95020433
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95098901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: