MEDICARE: RISE WELLNESS CENTER PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1124302278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISE WELLNESS CENTER PC

Provider Business Mailing Address
First Line	:	5030 BONITA RD
Second Line	:	STE. B
City	:	BONITA
State	:	CA
Zip	:	91902-1700
Country	:	US
Telephone Number	:	619-261-7027
Fax Number	:	619-479-9376

Provider Business Practice Location Address
First Line	:	15300 N 90TH ST
Second Line	:	STE 950
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-2771
Country	:	US
Telephone Number	:	480-941-2147
Fax Number	:	480-941-2157

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSE CANDELARIO
Credential	:	D.C.
Telephone Number	:	619-261-7027

Provider Enumeration Date	:	10/07/2011
Last Update Date	:	02/24/2012

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