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General NPI Number Information
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NPI Number | 1437404142
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Entity Type | Organization
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Legal Business Name | WILLIAM C TA MDSPECTRUM MEDICAL & WELLNESS CENTER
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 07/18/2012
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Provider Practice Location Address
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Address Line | 15095 AMARGOSA RD BLDG 2, STE 280
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City | VICTORVILLE
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State | CA
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Zip | 92394-1879
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Country | US
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Telephone | 760-952-9100
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Fax | 760-952-9228
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Provider Business Mailing Address
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Address Line | 15095 AMARGOSA RD BLDG 2, STE 280
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City | VICTORVILLE
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State | CA
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Zip | 92394-1879
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Country | US
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Telephone | 760-952-9100
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Fax | 760-952-9228
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DR. ONYENKWERE O OKWANDU
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Credential | PH.D.
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Telephone | 760-246-9555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | A118947
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License Number State | CA
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