Organization Active NPI

Absolute Wellness Medical Group LLC

  • Internal Medicine Physician
  • National City, CA
National Provider Identifier
1356835771
Registry record updated Jun 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ABSOLUTE WELLNESS MEDICAL GROUP LLC
Practice address
1430 E Plaza Blvd Ste E18
National City, CA 91950-3690
Phone
(619) 434-2813
Fax
(855) 631-3720
NPI assigned
Jun 19, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2018

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

Authorized official

Name
Nenita Mehlmauer
Title
Authorized Official
Phone
(619) 754-4955

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1430 E Plaza Blvd Ste E18
National City, CA 91950-3690

Mailing address

1430 E Plaza Blvd Ste E18
National City, CA 91950-3690
Phone (619) 434-2813

Other identifiers 2

IdentifierTypeStateIssuer
1073579173MedicaidCA
1700314978MedicaidCA

National Provider Directory

National Provider Directory

Locations

1430 E Plaza Blvd
Ste E18
National City, CA 91950
Phone (619) 267-0553

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1529366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529366400000",
    "number": "1356835771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 E PLAZA BLVD STE E18",
            "city": "NATIONAL CITY",
            "state": "CA",
            "postal_code": "919503690",
            "telephone_number": "619-434-2813",
            "fax_number": "855-631-3720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 E PLAZA BLVD STE E18",
            "city": "NATIONAL CITY",
            "state": "CA",
            "postal_code": "919503690",
            "telephone_number": "619-434-2813",
            "fax_number": "855-631-3720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABSOLUTE WELLNESS MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-19",
        "last_updated": "2018-06-19",
        "status": "A",
        "authorized_official_last_name": "MEHLMAUER",
        "authorized_official_first_name": "NENITA",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "619-754-4955"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073579173",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700314978",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in National City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2018; 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.