MEDICARE: WEWIN FOR HEALTH MEDICAL GROUP

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	261Q00000X	Clinic/Center	AJ1972579	CA
2	261QH0100X	Health Service Clinic/Center	NP6891	CA

General Provider Information

NPI Number	:	1699034694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEWIN FOR HEALTH MEDICAL GROUP

Provider Business Mailing Address
First Line	:	19015 TOWN CENTER DR STE 206
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-8996
Country	:	US
Telephone Number	:	760-240-4729
Fax Number	:	760-240-2338

Provider Business Practice Location Address
First Line	:	17868 US HIGHWAY 18
Second Line	:	PMB 359
City	:	APPLE VALLEY
State	:	CA
Zip	:	92307-1267
Country	:	US
Telephone Number	:	760-946-0212
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MS. SANDRA STEWART
Credential	:
Telephone Number	:	760-240-4729

Provider Enumeration Date	:	05/10/2012
Last Update Date	:	05/10/2012

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Directions to “WEWIN FOR HEALTH MEDICAL GROUP ” Practice Location

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