Provider Demographics
NPI:1598054447
Name:WEWIN FOR HEALTH
Entity Type:Organization
Organization Name:WEWIN FOR HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:760-240-4729
Mailing Address - Street 1:19015 TOWN CENTER DR STE 206
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-8996
Mailing Address - Country:US
Mailing Address - Phone:760-240-4729
Mailing Address - Fax:760-240-2338
Practice Address - Street 1:17868 HWY 18 PMB 359
Practice Address - Street 2:
Practice Address - City:APPLEVALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1267
Practice Address - Country:US
Practice Address - Phone:760-240-4729
Practice Address - Fax:760-240-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP6891363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty