Healthcare Provider Details

I. General information

NPI: 1548393119
Provider Name (Legal Business Name): WOMENS HEALTH & WELLNESS MEDICAL OFFICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40700 CALIFORNIA OAKS RD STE. 205
MURRIETA CA
92562-5789
US

IV. Provider business mailing address

40700 CALIFORNIA OAKS RD STE. 205
MURRIETA CA
92562-5789
US

V. Phone/Fax

Practice location:
  • Phone: 951-304-3180
  • Fax: 951-304-2735
Mailing address:
  • Phone: 951-304-3180
  • Fax: 951-304-2735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number428809
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number428809
License Number StateCA

VIII. Authorized Official

Name: MRS. MICHELE R BROAD
Title or Position: OWNER
Credential: RNP
Phone: 951-304-3180