Provider Demographics
NPI:1003420381
Name:TRANSFORMATION HEALTH & WELLNESS
Entity Type:Organization
Organization Name:TRANSFORMATION HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:CORTEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-900-3091
Mailing Address - Street 1:6200 E CANYON RIM RD STE 105B
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4313
Mailing Address - Country:US
Mailing Address - Phone:714-900-3091
Mailing Address - Fax:714-386-5147
Practice Address - Street 1:6200 E CANYON RIM RD STE 105B
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4313
Practice Address - Country:US
Practice Address - Phone:714-900-3091
Practice Address - Fax:714-386-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1982732236OtherNPI