Provider Demographics
NPI:1336432327
Name:SPECTRUM CARE & WELLNESS PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SPECTRUM CARE & WELLNESS PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SZETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-847-3960
Mailing Address - Street 1:PO BOX 2389
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91610-0389
Mailing Address - Country:US
Mailing Address - Phone:818-847-3960
Mailing Address - Fax:818-847-3997
Practice Address - Street 1:2601 W ALAMEDA AVE
Practice Address - Street 2:STE. 111
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4800
Practice Address - Country:US
Practice Address - Phone:818-847-3960
Practice Address - Fax:818-847-3997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty