Provider Demographics
NPI:1558815456
Name:WEE THRIVE PEDIATRIC THERAPY GROUP
Entity Type:Organization
Organization Name:WEE THRIVE PEDIATRIC THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/CFOO
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-872-9288
Mailing Address - Street 1:1031 AVENIDA PICO
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6352
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1031 AVENIDA PICO
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6352
Practice Address - Country:US
Practice Address - Phone:949-872-9288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty