WONDERFUL CENTER FOR HEALTH INNOVATION INC (NPI# 1871043653) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871043653 |
| Entity Type | Organization |
| Organization Name | WONDERFUL CENTER FOR HEALTH INNOVATION INC |
| Other Organization Name | WONDERFUL WELLNESS MOBILE |
| Practice Address |
13646 Highway 33 Lost Hills CA 93249-9719 |
| Practice Telephone | 6617976607 |
| Mailing Telephone | 6617976607 |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2019-09-03 |
| Authorized Official Name | DR. LARRY WOLK (CHIEF MEDICAL OFFICER) |
| Authorized Official Telephone | 6617202660 |
| Authorized Official Credential | MD MSPH |
| Is Organization Subpart | Y |
| Parent Organization Name | WONDERFUL CENTER FOR HEALTH INNOVATION INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
C140498 | CA | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Wonderful Wellness Mobile | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437756103 | Wonderful Center for Health Innovation Inc | Clinic/Center | 14848 Lamberson Ave, Lost Hills, CA 93249 | 2020-10-06 |
| 1811452493 | Wonderful Center for Health Innovation Inc | Clinic/Center | 2070 Veneto St, Delano, CA 93215-9122 | 2019-02-07 |
| 1750752804 | Wonderful Center for Health Innovation Inc | Clinic/Center | 13646 Highway 33, Lost Hills, CA 93249-9719 | 2015-10-15 |
| 1720454192 | Wonderful Center for Health Innovation Inc | Clinic/Center | 1701 S Lexington St, Delano, CA 93215-9200 | 2015-08-19 |
| Street Address |
13646 HIGHWAY 33 |
| City | LOST HILLS |
| State | CA |
| Zip Code | 93249-9719 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336337799 | Naomi Kamil Bjornstad | Physician Assistant | 13646 Highway 33, Lost Hills, CA 93249-9719 | 2007-10-11 |
| 1922528397 | Lizbeth Orozco Jauregui | Physician Assistant | 13646 Highway 33, Lost Hills, CA 93249-9719 | 2017-06-26 |
| 1750752804 | Wonderful Center for Health Innovation Inc | Clinic/Center | 13646 Highway 33, Lost Hills, CA 93249-9719 | 2015-10-15 |
| 1801231238 | Raymond Tsai | Family Medicine | 13646 Highway 33, Lost Hills, CA 93249-9719 | 2013-04-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437756103 | Wonderful Center for Health Innovation Inc | Clinic/Center | 14848 Lamberson Ave, Lost Hills, CA 93249 | 2020-10-06 |
| 1205241148 | Inga Wilder | Family Medicine | 21138 Paso Robles Hwy, Lost Hills, CA 93249 | 2014-06-30 |
| 1316144975 | Ludim Estuardo Vielman | Physician Assistant | 21138 Paso Robles Hwy, Lost Hills, CA 93249 | 2007-06-28 |
| 1952507600 | Clarissa Y De Castro | Dentist | 21138 Paso Robles Hwy, Lost Hills, CA 93249 | 2007-06-21 |
| 1376558221 | Omni Family Health | Clinic/Center | 21138 Paso Robles Hwy, Lost Hills, CA 93249-0306 | 2006-07-29 |
| 1649442088 | Omni Family Health | Clinical Medical Laboratory | 21138 Paso Robles Hwy, Lost Hills, CA 93249-0306 | 2008-03-26 |
| 1659590784 | Omni Family Health | Clinic/Center | 21138 Paso Robles Hwy, Lost Hills, CA 93249-0306 | 2007-04-25 |
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750752804 | Wonderful Center for Health Innovation Inc | Clinic/Center | 13646 Highway 33, Lost Hills, CA 93249-9719 | 2015-10-15 |
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| Find all providers with the same taxonomy | ||||
| City | LOST HILLS |
| Zip Code | 93249 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.