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General NPI Number Information
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NPI Number | 1548393119
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Entity Type | Organization
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Legal Business Name | WOMENS HEALTH & WELLNESS MEDICAL OFFICE, INC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 12/15/2015
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Provider Practice Location Address
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Address Line | 40700 CALIFORNIA OAKS RD STE. 205
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City | MURRIETA
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State | CA
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Zip | 92562-5789
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Country | US
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Telephone | 951-304-3180
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Fax | 951-304-2735
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Provider Business Mailing Address
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Address Line | 40700 CALIFORNIA OAKS RD STE. 205
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City | MURRIETA
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State | CA
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Zip | 92562-5789
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Country | US
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Telephone | 951-304-3180
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Fax | 951-304-2735
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MICHELE R BROAD
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Credential | RNP
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Telephone | 951-304-3180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 428809
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 428809
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License Number State | CA
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