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General NPI Number Information
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NPI Number | 1306463542
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Entity Type | Organization
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Legal Business Name | WELLHAVEN PRIMARY CARE
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Dates
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Enumeration Date | 07/04/2020
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Last Update Date | 07/04/2020
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Provider Practice Location Address
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Address Line | 5555 RESERVOIR DR STE 303
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City | SAN DIEGO
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State | CA
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Zip | 92120-5181
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Country | US
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Telephone | 619-752-2280
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Fax |
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Provider Business Mailing Address
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Address Line | 5663 BALBOA AVE # 517
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City | SAN DIEGO
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State | CA
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Zip | 92111-2705
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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 | DR. JILLION T HARRIS
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Credential | MD
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Telephone | 619-752-2280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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