Healthcare Provider Details

I. General information

NPI: 1952995615
Provider Name (Legal Business Name): COMMUNITY WELLNESS MEDICAL ASSOCIATES A PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 04/30/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 S 4TH ST STE 301
DANVILLE KY
40422-2081
US

IV. Provider business mailing address

1821 S BASCOM AVE # 383
CAMPBELL CA
95008-2309
US

V. Phone/Fax

Practice location:
  • Phone: 650-722-2611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL TINAMISAN CATAUSAN
Title or Position: MD
Credential:
Phone: 913-827-7273