Provider Demographics
NPI:1972285369
Name:WISHWELL LLC
Entity Type:Organization
Organization Name:WISHWELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERENICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ-HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MED, PPS,
Authorized Official - Phone:619-890-1602
Mailing Address - Street 1:2060 OTAY LAKES RD STE 240
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1364
Mailing Address - Country:US
Mailing Address - Phone:619-890-1602
Mailing Address - Fax:
Practice Address - Street 1:2060 OTAY LAKES RD STE 240
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-1364
Practice Address - Country:US
Practice Address - Phone:619-890-1602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty