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General NPI Number Information
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NPI Number | 1639061872
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Entity Type | Organization
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Legal Business Name | WELLNEST MEDICAL CLINIC CORP
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 1019 E HOLT AVE
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City | POMONA
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State | CA
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Zip | 91767-5720
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Country | US
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Telephone | 909-623-7799
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Fax |
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Provider Business Mailing Address
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Address Line | 1019 E HOLT AVE
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City | POMONA
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State | CA
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Zip | 91767-5720
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Country | US
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Telephone | 909-623-7799
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | LUCIEN ALEXANDRE
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Credential | MD
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Telephone | 909-623-7799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP1700X
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Taxonomy Name | Perinatal Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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