Provider Demographics
NPI:1407432289
Name:COMMUNITY WELLNESS AMERICA, INC
Entity Type:Organization
Organization Name:COMMUNITY WELLNESS AMERICA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN & CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:STERLING
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:858-367-3435
Mailing Address - Street 1:5835 HONORS DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-2255
Mailing Address - Country:US
Mailing Address - Phone:619-581-5900
Mailing Address - Fax:619-229-9666
Practice Address - Street 1:3111 CAMINO DEL RIO N STE 345
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5720
Practice Address - Country:US
Practice Address - Phone:858-367-3435
Practice Address - Fax:619-229-9666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1073783346Medicaid
CA1285737569Medicaid