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General NPI Number Information
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NPI Number | 1154777670
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Entity Type | Organization
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Legal Business Name | CLEAR WATERS HEALTH AND WELLNESS OF SACRAMENTO PC
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Dates
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Enumeration Date | 05/13/2016
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Last Update Date | 05/13/2016
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Provider Practice Location Address
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Address Line | 8950 CAL CENTER DR SUITE 165
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City | SACRAMENTO
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State | CA
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Zip | 95826-3259
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Country | US
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Telephone | 732-982-2674
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Fax |
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Provider Business Mailing Address
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Address Line | 3 CORBETT WAY
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City | EATONTOWN
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State | NJ
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Zip | 07724-2283
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IAN JOHNSON
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Credential |
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Telephone | 732-982-2674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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