Healthcare Provider Details

I. General information

NPI: 1467576025
Provider Name (Legal Business Name): SECOYA MEDICAL AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E ST
WASCO CA
93280-1918
US

IV. Provider business mailing address

PO BOX 793
WASCO CA
93280-0793
US

V. Phone/Fax

Practice location:
  • Phone: 661-758-5131
  • Fax:
Mailing address:
  • Phone: 661-758-5131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DENISS CAMPBELL
Title or Position: OWNER
Credential: DC
Phone: 661-758-5131