Provider Demographics
NPI:1194171454
Name:ADULT MEDICINE AND WELLNESS INC
Entity type:Organization
Organization Name:ADULT MEDICINE AND WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODRIGO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-476-9054
Mailing Address - Street 1:480 4TH AVE
Mailing Address - Street 2:SUITE 516
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4414
Mailing Address - Country:US
Mailing Address - Phone:619-476-9054
Mailing Address - Fax:619-476-9056
Practice Address - Street 1:480 4TH AVE
Practice Address - Street 2:SUITE 516
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4414
Practice Address - Country:US
Practice Address - Phone:619-476-9054
Practice Address - Fax:619-476-9056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty