Wondermed of California, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WONDERMED OF CALIFORNIA, INC

Practice address

828 Crestmoore PL
Venice, CA 90291-4931

Phone

(310) 692-1469

NPI assigned

Feb 14, 2022

Organization subpart

No

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

Authorized official

Name

Santino Labate

Title

Compliance

Phone

(949) 201-6090

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1644796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648425600000",
    "number": "1639824105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "828 CRESTMOORE PL",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902914931",
            "telephone_number": "310-692-1469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828 CRESTMOORE PL",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902914931",
            "telephone_number": "310-692-1469"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "333 Washington Blvd # 130",
            "address_purpose": "LOCATION",
            "city": "Marina Del Rey",
            "state": "CA",
            "postal_code": "902925152",
            "country_code": "US",
            "telephone_number": "310-692-1469",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WONDERMED OF CALIFORNIA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-14",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-18",
        "status": "A",
        "authorized_official_last_name": "LABATE",
        "authorized_official_first_name": "SANTINO",
        "authorized_official_title_or_position": "COMPLIANCE",
        "authorized_official_telephone_number": "949-201-6090"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Wilson
• Lowell Winer, LMFT
• Susan Winfield, LMFT
• Kristen Branch Winslow, LMFT, MBA
• Wonder Medicine of New York P.C.
• Wondermed of Florida, Inc
• Wondermed of Texas, P.a.
• Avery Wortham
• Erica Lee Wyatt
• John Michael Yamamoto, D.D.S., M.P.H.

• Family Medicine Physician in Venice, CA
• Providers in Venice, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; 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.