Provider Demographics
NPI:1023407913
Name:WELLNESS WAY
Entity type:Organization
Organization Name:WELLNESS WAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-222-7693
Mailing Address - Street 1:6540 LUSK BLVD
Mailing Address - Street 2:SUITE C175
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2767
Mailing Address - Country:US
Mailing Address - Phone:858-222-7693
Mailing Address - Fax:858-587-0707
Practice Address - Street 1:6540 LUSK BLVD
Practice Address - Street 2:SUITE C175
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2767
Practice Address - Country:US
Practice Address - Phone:858-222-7693
Practice Address - Fax:858-587-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16312171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty