Provider Demographics
NPI:1902039308
Name:WHEELER, NAXYELI SAMANTHA (MA)
Entity Type:Individual
Prefix:MRS
First Name:NAXYELI
Middle Name:SAMANTHA
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:NAXYELI
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29970 TECHNOLOGY DR STE 117B
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2647
Mailing Address - Country:US
Mailing Address - Phone:951-916-9955
Mailing Address - Fax:
Practice Address - Street 1:29970 TECHNOLOGY DR STE 117B
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2647
Practice Address - Country:US
Practice Address - Phone:951-916-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health