Healthcare Provider Details

I. General information

NPI: 1124038534
Provider Name (Legal Business Name): HEALTH AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 S DAKOTA AVE
VANDENBERG AFB CA
93437-6307
US

IV. Provider business mailing address

338 S DAKOTA AVE BLDG 13850
VANDENBERG AFB CA
93437-6307
US

V. Phone/Fax

Practice location:
  • Phone: 805-606-2221
  • Fax:
Mailing address:
  • Phone: 805-606-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELINDA S REED
Title or Position: REGISTERED DIETITIAN
Credential: RD
Phone: 805-606-2221