Healthcare Provider Details

I. General information

NPI: 1770911810
Provider Name (Legal Business Name): ORANGE COUNTY WELLNESS PHYSICIANS MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14120 BEACH BLVD STE 214
WESTMINSTER CA
92683-4454
US

IV. Provider business mailing address

14120 BEACH BLVD STE 214
WESTMINSTER CA
92683-4454
US

V. Phone/Fax

Practice location:
  • Phone: 866-303-9355
  • Fax:
Mailing address:
  • Phone: 866-303-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number31329
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number14140
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number27729
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG59013
License Number StateCA

VIII. Authorized Official

Name: DR. MATTHEW GRIFFITH
Title or Position: PRESIDENT
Credential: DC
Phone: 866-303-9533