Basic Information
| Provider Information | |||||||||
| NPI: | 1396480356 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY MEDICAL WELLNESS CENTERS USA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1360 E ANAHEIM ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908135515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622700324 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1533 ALAMITOS AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908132214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622700324 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2022 | ||||||||
| LastUpdateDate: | 05/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | RAMIREZ | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | HUMAN RESOURCES DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5624856274 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COMMUNITY MEDICAL WELLNESS CENTERS USA | ||||||||
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| NPICertificationDate: | 05/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.