MEDICARE: TRANSGENDER HEALTH AND WELLNESS CENTER

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	261QH0100X	Health Service Clinic/Center
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1447740824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSGENDER HEALTH AND WELLNESS CENTER

Provider Business Mailing Address
First Line	:	340 S FARRELL DR STE A208
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-7931
Country	:	US
Telephone Number	:	760-202-4308
Fax Number	:	760-818-8025

Provider Business Practice Location Address
First Line	:	340 S FARRELL DR STE A208
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-7931
Country	:	US
Telephone Number	:	760-202-4308
Fax Number	:	760-818-8025

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. THOMI CLINTON
Credential	:
Telephone Number	:	760-202-4308

Provider Enumeration Date	:	05/11/2018
Last Update Date	:	03/16/2021

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