Provider Demographics
NPI:1326112053
Name:WELLS, JOSEPH S (DPM)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:S
Last Name:WELLS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24640 JEFFERSON AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9027
Mailing Address - Country:US
Mailing Address - Phone:951-677-1323
Mailing Address - Fax:951-239-4233
Practice Address - Street 1:24640 JEFFERSON AVE STE 109
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9027
Practice Address - Country:US
Practice Address - Phone:951-677-1323
Practice Address - Fax:951-239-4233
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2077213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T11167Medicare UPIN
CA5499740001Medicare NSC