Healthcare Provider Details

I. General information

NPI: 1609972777
Provider Name (Legal Business Name): COMMUNITY MEDICAL WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12444 WASHINGTON BLVD
WHITTIER CA
90602-1005
US

IV. Provider business mailing address

12444 WASHINGTON BLVD
WHITTIER CA
90602-1005
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-0161
  • Fax: 562-698-8740
Mailing address:
  • Phone: 562-698-0161
  • Fax: 562-688-8740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA23965
License Number StateCA

VIII. Authorized Official

Name: ELIZA MARIE FERNANDO
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 562-461-7588