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General NPI Number Information
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NPI Number | 1578094496
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Entity Type | Organization
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Legal Business Name | MENS HEALTH AND WELLNESS CENTER USA PC
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 2755 BRISTOL ST 280
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City | COSTA MESA
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State | CA
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Zip | 92626-5985
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Country | US
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Telephone | 714-966-5362
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Fax | 714-966-5389
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Provider Business Mailing Address
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Address Line | 23275 S POINTE DR SUITE 100
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1474
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Country | US
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Telephone | 714-966-5352
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Fax | 714-966-5389
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Authorized Official
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Title or Position | DIRECTOR OF COMPLIANCE
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Name | MRS. JOAN SIMPSON
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Credential |
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Telephone | 615-562-4048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | C50947
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License Number State | CA
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