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General NPI Number Information
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NPI Number | 1407346208
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Entity Type | Organization
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Legal Business Name | PHOENIX HEALTH & WELLNESS PC
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Dates
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Enumeration Date | 05/16/2018
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Last Update Date | 06/08/2018
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Provider Practice Location Address
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Address Line | 576 N SUNRISE AVE STE 210
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City | ROSEVILLE
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State | CA
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Zip | 95661
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Country | US
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Telephone | 916-299-6051
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Fax | 916-581-6405
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Provider Business Mailing Address
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Address Line | 576 N SUNRISE AVE STE 210
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City | ROSEVILLE
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State | CA
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Zip | 95661-2847
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Country | US
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Telephone | 916-299-6501
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Fax | 916-581-6405
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | BERTINA MARIE HOOKS
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Credential | MD
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Telephone | 916-626-9869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A133270
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License Number State | CA
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