Provider Demographics
NPI:1407346208
Name:PHOENIX HEALTH & WELLNESS PC
Entity Type:Organization
Organization Name:PHOENIX HEALTH & WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BERTINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-626-9869
Mailing Address - Street 1:576 N SUNRISE AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2847
Mailing Address - Country:US
Mailing Address - Phone:916-299-6501
Mailing Address - Fax:916-581-6405
Practice Address - Street 1:576 N SUNRISE AVE STE 210
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-299-6051
Practice Address - Fax:916-581-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA133270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty