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General NPI Number Information
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NPI Number | 1811452493
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Entity Type | Organization
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Legal Business Name | WONDERFUL CENTER FOR HEALTH INNOVATION INC
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Dates
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Enumeration Date | 02/07/2019
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Last Update Date | 09/03/2019
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Provider Practice Location Address
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Address Line | 2070 VENETO ST
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City | DELANO
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State | CA
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Zip | 93215-9122
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Country | US
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Telephone | 661-221-4477
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Fax |
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Provider Business Mailing Address
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Address Line | 11444 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90064-1549
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Country | US
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Telephone | 310-966-8226
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. LARRY WOLK
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Credential | MD MSPH
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Telephone | 310-966-8226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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