Healthcare Provider Details

I. General information

NPI: 1629430335
Provider Name (Legal Business Name): WAYMAKERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14632 YORBA ST SUITES B & C
TUSTIN CA
92780-2554
US

IV. Provider business mailing address

440 EXCHANGE STE 250
IRVINE CA
92602-1390
US

V. Phone/Fax

Practice location:
  • Phone: 714-714-0780
  • Fax: 714-884-4309
Mailing address:
  • Phone: 714-714-0780
  • Fax: 714-884-4309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RONNETTA JOHNSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 949-250-0488