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General NPI Number Information
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NPI Number | 1952995615
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Entity Type | Organization
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Legal Business Name | COMMUNITY WELLNESS MEDICAL ASSOCIATES A PC
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Dates
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Enumeration Date | 02/23/2021
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 304 S 4TH ST STE 301
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City | DANVILLE
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State | KY
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Zip | 40422-2081
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Country | US
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Telephone | 650-722-2611
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Fax |
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Provider Business Mailing Address
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Address Line | 1821 S BASCOM AVE # 383
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City | CAMPBELL
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State | CA
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Zip | 95008-2309
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD
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Name | MICHAEL TINAMISAN CATAUSAN
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Credential |
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Telephone | 913-827-7273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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