=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831407410
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WORKPLACE WELLNESS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2010
-----------------------------------------------------
Last Update Date | 09/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2861 TURPIN AVE
-----------------------------------------------------
City | RIVERBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-505-1031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2861 TURPIN AVENUE
-----------------------------------------------------
City | RIVERBANK
-----------------------------------------------------
State | CALIFORNIA
-----------------------------------------------------
Zip | 95367
-----------------------------------------------------
Country | UM
-----------------------------------------------------
Telephone | 209-505-1031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MSW INTERN
-----------------------------------------------------
Name | ANA MARIA CALDERON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 209-505-1031
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------