NPIMap

Organization Active NPI

La Concordia Wellness Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Concord, CA
National Provider Identifier
1629753132
Registry record updated Jun 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
LA CONCORDIA WELLNESS CENTER
Practice address
1070 Concord Ave Ste 105
Concord, CA 94520-5608
Phone
(925) 849-4695
Fax
(925) 270-3382
NPI assigned
Jun 21, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2023

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

Authorized official

Name
Dr. Manuel E Fernandez, PSYD
Title
Ceo
Phone
(925) 849-4761

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

1070 Concord Ave Ste 105
Concord, CA 94520-5608

Mailing address

1070 Concord Ave Ste 105
Concord, CA 94520-5608
Phone (925) 849-4695

National Provider Directory

National Provider Directory

Locations

1070 Concord Ave
Ste 105
Concord, CA 94520
Phone (925) 849-4695

Practitioners & affiliated clinicians

Practitioners 8

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": "1687305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687305600000",
    "number": "1629753132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 CONCORD AVE STE 105",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945205608",
            "telephone_number": "925-849-4695",
            "fax_number": "925-270-3382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1070 CONCORD AVE STE 105",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945205608",
            "telephone_number": "925-849-4695",
            "fax_number": "925-270-3382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CONCORDIA WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-21",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A",
        "authorized_official_last_name": "FERNANDEZ",
        "authorized_official_first_name": "MANUEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "925-849-4761",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 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.