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General NPI Number Information
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NPI Number | 1356150742
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Entity Type | Organization
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Legal Business Name | NEUROWELL MEDICAL GROUP
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Dates
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Enumeration Date | 12/31/2024
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 1820 W ORANGEWOOD AVE STE 105
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City | ORANGE
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State | CA
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Zip | 92868-5052
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Country | US
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Telephone | 805-900-7672
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Fax |
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Provider Business Mailing Address
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Address Line | 882 AUKLET CT
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-5539
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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 | VP
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Name | BRADLEY K GUION
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Credential |
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Telephone | 602-503-9869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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