Provider Demographics
NPI:1518944032
Name:KATELLA WELLNESS CENTER INC
Entity Type:Organization
Organization Name:KATELLA WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:562-598-0600
Mailing Address - Street 1:5122 KATELLA AVE
Mailing Address - Street 2:#210
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2826
Mailing Address - Country:US
Mailing Address - Phone:562-598-0600
Mailing Address - Fax:562-598-0678
Practice Address - Street 1:5122 KATELLA AVE
Practice Address - Street 2:#210
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2826
Practice Address - Country:US
Practice Address - Phone:562-598-0600
Practice Address - Fax:562-598-0678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18752OtherMEDICARE GROUP NUMBER