Provider Demographics
NPI:1225836133
Name:FUNDAMENTAL HEALTH
Entity type:Organization
Organization Name:FUNDAMENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WYATT
Authorized Official - Middle Name:
Authorized Official - Last Name:HINSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-728-5065
Mailing Address - Street 1:571 HYGEIA AVE, C
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2652
Mailing Address - Country:US
Mailing Address - Phone:619-728-5065
Mailing Address - Fax:
Practice Address - Street 1:571 HYGEIA AVE, C
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2652
Practice Address - Country:US
Practice Address - Phone:619-728-5065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-05
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty