Healthcare Provider Details

I. General information

NPI: 1205668787
Provider Name (Legal Business Name): GENERATIONAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27420 JEFFERSON AVE SUITE 101B
TEMECULA CA
92590
US

IV. Provider business mailing address

27420 JEFFERSON AVE SUITE 101B
TEMECULA CA
92590
US

V. Phone/Fax

Practice location:
  • Phone: 951-208-7584
  • Fax:
Mailing address:
  • Phone: 951-208-7584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DYLAN SCHUBERT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 951-208-7584