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General NPI Number Information
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NPI Number | 1750798211
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Entity Type | Organization
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Legal Business Name | WE RECOVER MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 07/16/2014
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Provider Practice Location Address
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Address Line | 41655 DATE ST SUITE 101
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City | MURRIETA
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State | CA
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Zip | 92562-7040
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Country | US
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Telephone | 866-920-1275
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Fax | 866-632-9472
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Provider Business Mailing Address
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Address Line | 41655 DATE ST SUITE 101
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City | MURRIETA
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State | CA
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Zip | 92562-7040
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Country | US
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Telephone | 866-920-1275
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Fax | 866-632-9472
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Authorized Official
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Title or Position | CONSULTING MEDICAL DIRECTOR/ PSYCHI
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Name | DR. KEERTHY SUNDER
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Credential | M.D.
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Telephone | 510-685-2022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State | CA
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