Wellness Diagnostics

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

K11111 Issued in CA

Legal business name

WELLNESS DIAGNOSTICS

Practice address

854 Emerald Bay Rd Ste C
South Lake Tahoe, CA 96150-6438

Phone

(530) 544-2020

NPI assigned

Jan 17, 2012

Last updated

Jan 17, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Smith

Title

Cfo

Phone

(904) 791-6471

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.

• Wanda

  • Physical Disabilities Residential Treatment Facility
  • Rialto, CA
  • NPI 1538322656
  NPD tax ID

Locations

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

{
    "created_epoch": "1326758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326758400000",
    "number": "1972874303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "854 EMERALD BAY RD STE C",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961506438",
            "telephone_number": "530-544-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "854 EMERALD BAY RD STE C",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961506438",
            "telephone_number": "530-544-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS DIAGNOSTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-17",
        "last_updated": "2012-01-17",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "904-791-6471"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "K11111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah Walsh, FNP-BC
• Amanda Stevens Weavil, MD
• Dustin John Wedekind
• Eve-Marie Welch, PA
• Joshua Welch, D.C.
• Patience Wenck, FNP
• Charles Patrick Wettach, PT
• Lauren White
• Brent Maxwell Wilkinson, D.O.
• Susan E Willey

• Ambulatory Surgical Clinic/Center in South Lake Tahoe, CA
• Providers in South Lake Tahoe, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 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.