Provider Demographics
NPI:1770031312
Name:MARK A WELCH DO, INC
Entity Type:Organization
Organization Name:MARK A WELCH DO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:951-966-5802
Mailing Address - Street 1:10737 LAUREL ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3837
Mailing Address - Country:US
Mailing Address - Phone:909-989-5556
Mailing Address - Fax:909-989-5558
Practice Address - Street 1:10737 LAUREL ST
Practice Address - Street 2:SUITE 230
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3837
Practice Address - Country:US
Practice Address - Phone:909-989-5556
Practice Address - Fax:909-989-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2OA89502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty