MEDICARE: CJ WELLNET INC

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	343900000X	Non-emergency Medical Transport (VAN)	MTN01188F	CA
2	343900000X	Non-emergency Medical Transport (VAN)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558448167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CJ WELLNET INC

Provider Business Mailing Address
First Line	:	2021 E 4TH ST.
Second Line	:	209
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3913
Country	:	US
Telephone Number	:	714-665-6591
Fax Number	:	714-632-8409

Provider Business Practice Location Address
First Line	:	2021 E 4TH ST.
Second Line	:	209
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3913
Country	:	US
Telephone Number	:	714-665-6591
Fax Number	:	714-632-8409

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. MATTHEW F. SPROWLS
Credential	:
Telephone Number	:	714-337-1671

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	12/17/2019

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Directions to “CJ WELLNET INC ” Practice Location

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