Healthcare Provider Details

I. General information

NPI: 1881245231
Provider Name (Legal Business Name): WELL COAST MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 11/05/2026
Certification Date: 11/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 MARKET ST STE 1608
SAN FRANCISCO CA
94104-5317
US

IV. Provider business mailing address

582 MARKET ST STE 1608
SAN FRANCISCO CA
94104-5317
US

V. Phone/Fax

Practice location:
  • Phone: 833-931-1716
  • Fax: 866-519-5427
Mailing address:
  • Phone: 833-931-1716
  • Fax: 866-519-5427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE GUCHEREAU
Title or Position: CEO
Credential: MD
Phone: 833-931-1716