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General NPI Number Information
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NPI Number | 1932816295
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Entity Type | Organization
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Legal Business Name | FOUR WELLNESS CLINIC INC
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Dates
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Enumeration Date | 11/04/2022
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Last Update Date | 11/04/2022
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Provider Practice Location Address
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Address Line | 21300 SHERMAN WAY STE 3
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City | CANOGA PARK
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State | CA
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Zip | 91303-3672
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Country | US
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Telephone | 818-835-9039
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Fax | 818-900-2478
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Provider Business Mailing Address
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Address Line | 21300 SHERMAN WAY STE 3
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City | CANOGA PARK
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State | CA
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Zip | 91303-3672
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Country | US
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Telephone | 818-835-9039
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Fax | 818-900-2478
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD PARK
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Credential | MD
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Telephone | 818-835-9039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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