Provider Demographics
NPI:1851658850
Name:WELLS, CORNELL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CORNELL
Middle Name:
Last Name:WELLS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:CORNELL
Other - Middle Name:
Other - Last Name:WELLS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1511 W GARVEY AVE N
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2138
Mailing Address - Country:US
Mailing Address - Phone:626-960-4844
Mailing Address - Fax:
Practice Address - Street 1:1511 W GARVEY AVE N
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2138
Practice Address - Country:US
Practice Address - Phone:626-960-4844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1316352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry