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General NPI Number Information
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NPI Number | 1609299320
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Entity Type | Organization
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Legal Business Name | SUPERIOR HEALTH & WELLNESS MEDICAL GROUP A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/31/2014
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Last Update Date | 08/18/2014
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Provider Practice Location Address
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Address Line | 22224 LA PALMA AVE SUITE A
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City | YORBA LINDA
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State | CA
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Zip | 92887-3819
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Country | US
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Telephone | 714-696-7769
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Fax | 714-696-7949
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Provider Business Mailing Address
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Address Line | 22224 LA PALMA AVE SUITE A
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City | YORBA LINDA
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State | CA
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Zip | 92887-3819
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Country | US
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Telephone | 714-696-7769
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Fax | 714-696-7949
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ANDREW GERMANOVICH
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Credential | DO
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Telephone | 714-696-7769
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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 | 20A12144
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License Number State | CA
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