Provider Demographics
NPI:1841713732
Name:WELLSPACE HEALTH PROFESSIONAL HEALTH CENTER FOR WOMEN
Entity type:Organization
Organization Name:WELLSPACE HEALTH PROFESSIONAL HEALTH CENTER FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY LICENSING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:ALAIN
Authorized Official - Last Name:BUCHIN-STETLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-550-5481
Mailing Address - Street 1:1820 J ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-3010
Mailing Address - Country:US
Mailing Address - Phone:916-550-5481
Mailing Address - Fax:916-520-3921
Practice Address - Street 1:4150 TRUXEL RD STE C
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-3761
Practice Address - Country:US
Practice Address - Phone:916-550-5481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLSPACE HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-21
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty