Provider Demographics
NPI:1225926298
Name:WELLS, ANTHONY CORNELIUS
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:CORNELIUS
Last Name:WELLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 INLAND EMPIRE BLVD STE C315
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4986
Mailing Address - Country:US
Mailing Address - Phone:909-743-5226
Mailing Address - Fax:
Practice Address - Street 1:3602 INLAND EMPIRE BLVD STE C315
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4986
Practice Address - Country:US
Practice Address - Phone:909-743-5226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker