=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720528722
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WARRIOR WELLNESS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2017
-----------------------------------------------------
Last Update Date | 02/24/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 930 SUNNYSLOPE RD SUITE A4
-----------------------------------------------------
City | HOLLISTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95023-5615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-630-5754
-----------------------------------------------------
Fax | 831-630-5786
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 843 SAN BENITO ST
-----------------------------------------------------
City | HOLLISTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95023-4878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-630-5754
-----------------------------------------------------
Fax | 831-630-5786
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ARIEL MORENO HURTADO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 415-672-4049
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 3988926
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------