Healthcare Provider Details

I. General information

NPI: 1609299320
Provider Name (Legal Business Name): SUPERIOR HEALTH & WELLNESS MEDICAL GROUP A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22224 LA PALMA AVE SUITE A
YORBA LINDA CA
92887-3819
US

IV. Provider business mailing address

22224 LA PALMA AVE SUITE A
YORBA LINDA CA
92887-3819
US

V. Phone/Fax

Practice location:
  • Phone: 714-696-7769
  • Fax: 714-696-7949
Mailing address:
  • Phone: 714-696-7769
  • Fax: 714-696-7949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number20A12144
License Number StateCA

VIII. Authorized Official

Name: ANDREW GERMANOVICH
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 714-696-7769