Provider Demographics
NPI:1235335928
Name:WAKELIN MCNEEL III MD
Entity Type:Organization
Organization Name:WAKELIN MCNEEL III MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WAKELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-332-0556
Mailing Address - Street 1:750 TERRADO PLZ
Mailing Address - Street 2:STE 40
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3419
Mailing Address - Country:US
Mailing Address - Phone:626-332-0556
Mailing Address - Fax:626-332-6587
Practice Address - Street 1:4619 ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1478
Practice Address - Country:US
Practice Address - Phone:626-286-1191
Practice Address - Fax:626-332-6587
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR HEALTHY LIVING MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-21
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG789332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G789330Medicaid
CAG46730Medicare UPIN
CA00G789330Medicaid