Healthcare Provider Details

I. General information

NPI: 1447740824
Provider Name (Legal Business Name): TRANSGENDER HEALTH AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 S FARRELL DR STE A208
PALM SPRINGS CA
92262-7931
US

IV. Provider business mailing address

340 S FARRELL DR STE A208
PALM SPRINGS CA
92262-7931
US

V. Phone/Fax

Practice location:
  • Phone: 760-202-4308
  • Fax: 760-818-8025
Mailing address:
  • Phone: 760-202-4308
  • Fax: 760-818-8025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. THOMI CLINTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 760-202-4308