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General NPI Number Information
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NPI Number | 1336489376
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Entity Type | Organization
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Legal Business Name | SIENNA WELLNES WALK-IN CLINIC
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Dates
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Enumeration Date | 02/28/2013
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 6425 LYNCH CANYON DR
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City | LAKE ISABELLA
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State | CA
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Zip | 93240-9726
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Country | US
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Telephone | 760-379-8630
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Fax | 760-379-7658
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Provider Business Mailing Address
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Address Line | 6425 LYNCH CANYON DR
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City | LAKE ISABELLA
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State | CA
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Zip | 93240-9726
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Country | US
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Telephone | 760-379-8630
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Fax | 760-379-7658
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT LEE GROSS
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Credential | DO
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Telephone | 760-379-8630
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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 | 20A7951
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License Number State | CA
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