Healthcare Provider Details

I. General information

NPI: 1982303079
Provider Name (Legal Business Name): HEALTHY MEDICAL WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4193 FLAT ROCK DR STE 200
RIVERSIDE CA
92505-7113
US

IV. Provider business mailing address

5120 HAMNER AVE STE 140 #568
EASTVALE CA
91752
US

V. Phone/Fax

Practice location:
  • Phone: 626-208-9377
  • Fax:
Mailing address:
  • Phone: 626-208-9377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDY LIU
Title or Position: PHYSICIAN
Credential: DO
Phone: 626-208-9377