Healthcare Provider Details

I. General information

NPI: 1285524728
Provider Name (Legal Business Name): HEALTH AND WELLNESS OF CALIFORNIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 CLAREMONT AVE # 100
STOCKTON CA
95207-5700
US

IV. Provider business mailing address

5250 CLAREMONT AVE # 100
STOCKTON CA
95207-5700
US

V. Phone/Fax

Practice location:
  • Phone: 702-683-9050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHAKAUWRA SANDOVAL
Title or Position: CEO
Credential:
Phone: 702-683-9050