Provider Demographics
NPI:1386802940
Name:HEALTH AND WELLNESS CENTER, INC.
Entity type:Organization
Organization Name:HEALTH AND WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:MAHMOOD
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-770-7301
Mailing Address - Street 1:23672 BIRTCHER RD.,
Mailing Address - Street 2:UNIT A
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1711
Mailing Address - Country:US
Mailing Address - Phone:949-770-7301
Mailing Address - Fax:949-770-0634
Practice Address - Street 1:23672 BIRTCHER RD.
Practice Address - Street 2:UNIT A
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1711
Practice Address - Country:US
Practice Address - Phone:949-770-7301
Practice Address - Fax:949-770-0634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A836880Medicaid
CA00A836880Medicaid