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General NPI Number Information
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NPI Number | 1225314107
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Entity Type | Organization
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Legal Business Name | WELLCARE MEDICAL GROUP
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 16415 S COLORADO AVENUE SUITE 208
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City | PARAMOUNT
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State | CA
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Zip | 90723-5054
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Country | US
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Telephone | 562-531-0015
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Fax | 562-531-4856
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Provider Business Mailing Address
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Address Line | 16415 S COLORADO AVENUE SUITE 208
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City | PARAMOUNT
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State | CA
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Zip | 90723-5054
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Country | US
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Telephone | 562-531-0015
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Fax | 562-531-4856
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. RICHARD W LEE
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Credential | MD
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Telephone | 562-531-0015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A85452
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License Number State | CA
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