Wanda

Primary specialty

Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X

License

320700000X Issued in CA

Legal business name

WANDA

Practice address

3730 Fernwood Ave
Rialto, CA 92377-2724

Phone

(909) 823-3703

Fax

(909) 823-3703

NPI assigned

Jul 9, 2008

Organization subpart

No

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

Authorized official

Name

Ms. Wanda Jean Smith, LVN

Title

LVN

Phone

(909) 496-2440

Specialties & licenses 1

Addresses

Tax ID family

Wanda2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

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  NPD tax ID

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

{
    "created_epoch": "1215561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1538322656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3730 FERNWOOD AVE",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923772724",
            "telephone_number": "909-823-3703",
            "fax_number": "909-823-3703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3730 FERNWOOD AVE",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923772724",
            "telephone_number": "909-823-3703",
            "fax_number": "909-823-3703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WANDA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-09",
        "last_updated": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "WANDA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "LVN",
        "authorized_official_telephone_number": "909-496-2440",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LVN"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "CA",
            "license": "320700000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Disabilities Residential Treatment Facility in Rialto, CA
• Providers in Rialto, CA by specialty
• Physical Disabilities Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; 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.