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General NPI Number Information
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NPI Number | 1568645935
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Entity Type | Organization
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Legal Business Name | GENERATIONS WELLNESS AND URGENT CARE APMC
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Dates
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Enumeration Date | 12/09/2007
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Last Update Date | 04/24/2009
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Provider Practice Location Address
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Address Line | 9515 SOQUEL DR SUITE 100
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City | APTOS
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State | CA
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Zip | 95003-4135
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Country | US
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Telephone | 831-662-9355
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Fax | 831-662-9358
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Provider Business Mailing Address
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Address Line | 9515 SOQUEL DR SUITE 100
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City | APTOS
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State | CA
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Zip | 95003-4135
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Country | US
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Telephone | 831-662-9355
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Fax | 831-662-9358
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. JOHN WESLEY ELLIOTT
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Credential | MD, MBA
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Telephone | 831-662-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | C40989
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License Number State | CA
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