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General NPI Number Information
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NPI Number | 1558448167
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Entity Type | Organization
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Legal Business Name | CJ WELLNET INC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 12/17/2019
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Provider Practice Location Address
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Address Line | 2021 E 4TH ST. 209
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City | SANTA ANA
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State | CA
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Zip | 92705-3913
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Country | US
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Telephone | 714-665-6591
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Fax | 714-632-8409
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Provider Business Mailing Address
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Address Line | 2021 E 4TH ST. 209
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City | SANTA ANA
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State | CA
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Zip | 92705-3913
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Country | US
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Telephone | 714-665-6591
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Fax | 714-632-8409
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. MATTHEW F. SPROWLS
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Credential |
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Telephone | 714-337-1671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | MTN01188F
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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