Medical Wellness Group, Inc.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

3978244 Issued in CA

Legal business name

MEDICAL WELLNESS GROUP, INC.

Practice address

41749 Brownstown Dr
Bermuda Dunes, CA 92203-1042

Phone

(760) 636-9893

NPI assigned

Jan 26, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lawrence E Le Roy, DC

Title

Ceo

Phone

(760) 360-8700

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1485388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660694400000",
    "number": "1063959187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41749 BROWNSTOWN DR",
            "city": "BERMUDA DUNES",
            "state": "CA",
            "postal_code": "922031042",
            "telephone_number": "760-636-9893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41749 BROWNSTOWN DR",
            "city": "BERMUDA DUNES",
            "state": "CA",
            "postal_code": "922031042",
            "telephone_number": "760-636-9893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL WELLNESS GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-26",
        "last_updated": "2022-08-17",
        "certification_date": "2021-05-08",
        "status": "A",
        "authorized_official_last_name": "LE ROY",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "760-360-8700",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "3978244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• James R Mawhiney, DPT
• Bridgid McQuown, EDD
• Kristin Metz, PTA
• Noelle Diane Millsap Harriman
• Nicole Mitchell, PTA
• Richard Winfield Moore III, PHARMD
• Andrea Morales, DPT

• General Practice Physician in Bermuda Dunes, CA
• Providers in Bermuda Dunes, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.