William C Ta Mdspectrum Medical & Wellness Center

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

A118947 Issued in CA

Legal business name

WILLIAM C TA MDSPECTRUM MEDICAL & WELLNESS CENTER

Practice address

15095 Amargosa Rd
BLDG 2, Ste 280
Victorville, CA 92394-1879

Phone

(760) 952-9100

Fax

(760) 952-9228

NPI assigned

Jul 18, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Onyenkwere O Okwandu, PH.D.

Title

Office Manager

Phone

(760) 246-9555

Specialties & licenses 1

Addresses

Other names 1

• SPECTRUM MEDICAL & WELLNESS CENTER Doing business as

Locations

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

{
    "created_epoch": "1342569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342569600000",
    "number": "1437404142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15095 AMARGOSA RD",
            "address_2": "BLDG 2, STE 280",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923941879",
            "telephone_number": "760-952-9100",
            "fax_number": "760-952-9228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15095 AMARGOSA RD",
            "address_2": "BLDG 2, STE 280",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923941879",
            "telephone_number": "760-952-9100",
            "fax_number": "760-952-9228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM C TA MDSPECTRUM MEDICAL & WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-18",
        "last_updated": "2012-07-18",
        "status": "A",
        "authorized_official_last_name": "OKWANDU",
        "authorized_official_first_name": "ONYENKWERE",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "760-246-9555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "A118947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SPECTRUM MEDICAL & WELLNESS CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katherine Christine Wilcox, MD
• Wildwood Court LLC
• Lashalle Wiley
• Amy Louise Wilkin, A.T.,C.
• William a. Jacobson, M.D.
• Jacquelyn Renee Williams Brooks, LCSW
• Cassidy Monique Williams
• Daeja Williams
• Danielle Williams
• Demetrius Shamond Williams, LVN

• Clinic/Center in Victorville, CA
• Providers in Victorville, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2012; 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.