Provider Demographics
NPI:1699034694
Name:WEWIN FOR HEALTH MEDICAL GROUP
Entity Type:Organization
Organization Name:WEWIN FOR HEALTH MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
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 US HIGHWAY 18
Practice Address - Street 2:PMB 359
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1267
Practice Address - Country:US
Practice Address - Phone:760-946-0212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAJ1972579261Q00000X
CANP6891261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center