MEDICARE: CHARLES WAYNE WELDE MA

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	106H00000X	Marriage & Family Therapist	IMF45796	CA

General Provider Information

NPI Number	:	1366578619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES WAYNE WELDE MA

Provider Business Mailing Address
First Line	:	PO BOX 1201
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91793-1201
Country	:	US
Telephone Number	:	626-962-2179
Fax Number	:

Provider Business Practice Location Address
First Line	:	3208 ROSEMEAD BLVD
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-2830
Country	:	US
Telephone Number	:	626-227-7001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/08/2007

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Directions to “ CHARLES WAYNE WELDE MA” Practice Location

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