Provider Demographics
NPI:1124302278
Name:RISE WELLNESS CENTER PC
Entity type:Organization
Organization Name:RISE WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDELARIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-261-7027
Mailing Address - Street 1:5030 BONITA RD
Mailing Address - Street 2:STE. B
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1700
Mailing Address - Country:US
Mailing Address - Phone:619-261-7027
Mailing Address - Fax:619-479-9376
Practice Address - Street 1:15300 N 90TH ST
Practice Address - Street 2:STE 950
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2771
Practice Address - Country:US
Practice Address - Phone:480-941-2147
Practice Address - Fax:480-941-2157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty