Healthcare Provider Details

I. General information

NPI: 1932196847
Provider Name (Legal Business Name): CORDELIA KNOTT WELLNESS FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S MAIN ST SUITE 100
ORANGE CA
92868-3851
US

IV. Provider business mailing address

230 S MAIN ST SUITE 100
ORANGE CA
92868-3851
US

V. Phone/Fax

Practice location:
  • Phone: 714-541-5563
  • Fax: 714-619-3336
Mailing address:
  • Phone: 714-541-5563
  • Fax: 714-619-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberC20007
License Number StateCA

VIII. Authorized Official

Name: MS. SHIRLEY JOYCE MORETTI
Title or Position: PRESIDENT
Credential:
Phone: 714-569-0318