Healthcare Provider Details

I. General information

NPI: 1629538806
Provider Name (Legal Business Name): WENDY C IRAGORRI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 E IMPERIAL HWY STE 220&240
LYNWOOD CA
90262-2659
US

IV. Provider business mailing address

3680 E IMPERIAL HWY STE 220&240
LYNWOOD CA
90262-2659
US

V. Phone/Fax

Practice location:
  • Phone: 323-769-7174
  • Fax:
Mailing address:
  • Phone: 323-769-7174
  • 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: