Provider Demographics
NPI:1104357235
Name:MEN'S HEALTH AND WELLNESS CENTER USA PC
Entity Type:Organization
Organization Name:MEN'S HEALTH AND WELLNESS CENTER USA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:BELLMAN
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-562-4048
Mailing Address - Street 1:23275 S POINTE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1474
Mailing Address - Country:US
Mailing Address - Phone:949-200-6612
Mailing Address - Fax:
Practice Address - Street 1:2810 CAMINO DEL RIO S
Practice Address - Street 2:116
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3818
Practice Address - Country:US
Practice Address - Phone:619-564-8923
Practice Address - Fax:619-677-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50947174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty