Healthcare Provider Details

I. General information

NPI: 1457564981
Provider Name (Legal Business Name): MALINDA JO WHEELER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3373 CERRITOS AVE
LOS ALAMITOS CA
90720
US

IV. Provider business mailing address

PO BOX 2273
LOS ALAMITOS CA
90720
US

V. Phone/Fax

Practice location:
  • Phone: 562-430-6220
  • Fax: 562-431-3947
Mailing address:
  • Phone: 562-430-6220
  • Fax: 562-431-3947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8249
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number356472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: