Provider Demographics
NPI:1457954224
Name:CORPORATE PARK WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:CORPORATE PARK WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER AND SHARE HOLDER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-550-0788
Mailing Address - Street 1:43 CORPORATE PARK STE 204
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5137
Mailing Address - Country:US
Mailing Address - Phone:714-550-0788
Mailing Address - Fax:714-550-6001
Practice Address - Street 1:43 CORPORATE PARK STE 204
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5137
Practice Address - Country:US
Practice Address - Phone:714-550-0788
Practice Address - Fax:714-550-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty