MEDICARE: WELLSPACE HEALTH

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	261QF0400X	Federally Qualified Health Center (FQHC)
2	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1669982237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSPACE HEALTH

Provider Business Mailing Address
First Line	:	1500 EXPO PKWY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4227
Country	:	US
Telephone Number	:	916-469-4705
Fax Number	:	916-880-5552

Provider Business Practice Location Address
First Line	:	216 N LINCOLN WAY STE 10
Second Line	:
City	:	GALT
State	:	CA
Zip	:	95632-1715
Country	:	US
Telephone Number	:	209-259-2090
Fax Number	:	209-259-3008

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	ALASDAIR JONATHAN PORTEUS
Credential	:	PHD
Telephone Number	:	916-550-5444

Provider Enumeration Date	:	10/09/2017
Last Update Date	:	03/13/2024

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Directions to “WELLSPACE HEALTH ” Practice Location

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