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General NPI Number Information
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NPI Number | 1740519727
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Entity Type | Organization
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Legal Business Name | SANTA CLARA WELLNESS CENTER
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Dates
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Enumeration Date | 12/21/2009
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Last Update Date | 01/08/2010
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Provider Practice Location Address
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Address Line | 2179 TULLY RD
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City | SAN JOSE
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State | CA
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Zip | 95122-1346
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Country | US
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Telephone | 408-258-8050
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Fax | 408-258-2269
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Provider Business Mailing Address
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Address Line | 2179 TULLY RD
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City | SAN JOSE
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State | CA
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Zip | 95122-1346
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Country | US
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Telephone | 408-258-8050
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Fax | 408-258-2269
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE E. WETTACH
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Credential | M.D.
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Telephone | 408-258-8050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C31903
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License Number State | CA
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