Watergreen Medical Supply Inc

Primary specialty

Inpatient HospiceTaxonomy code 315D00000X

Legal business name

WATERGREEN MEDICAL SUPPLY INC

Practice address

2875 Douglas Way
Corona, CA 92882-6066

Phone

(714) 651-8059

NPI assigned

Dec 14, 2013

Organization subpart

No

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

Authorized official

Name

Ron Trejo

Title

President

Phone

(714) 651-8059

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1386979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386979200000",
    "number": "1467873646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2875 DOUGLAS WAY",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928826066",
            "telephone_number": "714-651-8059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2875 DOUGLAS WAY",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928826066",
            "telephone_number": "714-651-8059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERGREEN MEDICAL SUPPLY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-14",
        "last_updated": "2013-12-14",
        "status": "A",
        "authorized_official_last_name": "TREJO",
        "authorized_official_first_name": "RON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-651-8059"
    },
    "taxonomies": [
        {
            "code": "315D00000X",
            "taxonomy_group": "",
            "desc": "Hospice, Inpatient",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hayley Nicole Washington, ED.S., PPS
• Kaja Washington
• Ustina Wasif
• Noreen Wasim
• Brianna Marie Waterbury, BCBA
• Fred M Watkins, M.D.
• Tierney Watkins
• Troy Watkins
• Deneen Leo Watson, MS. LMFT, CADC-II
• Andrea Nicole Wayne

• Inpatient Hospice in Corona, CA
• Providers in Corona, CA by specialty
• Inpatient Hospice in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2013; 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.