MEDICARE: DANIEL W WELCH

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	172V00000X	Community Health Worker	019874	AZ

General Provider Information

NPI Number	:	1992286751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL W WELCH

Provider Business Mailing Address
First Line	:	1335 S PACIFIC AVE STE 209
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85365-1735
Country	:	US
Telephone Number	:	928-919-8396
Fax Number	:

Provider Business Practice Location Address
First Line	:	1335 S PACIFIC AVE STE 209
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85365-1735
Country	:	US
Telephone Number	:	928-919-8396
Fax Number	:

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

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	08/28/2018

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