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INNOVATIVE WELLNESS CLINIC INC. A NURSING CORPORATION NPI 1316535776


NPI Information

NPI: 1316535776
Provider Name: INNOVATIVE WELLNESS CLINIC, INC., A NURSING CORPORATION

Doing Business As: IWC PRIMARY CARE

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 05D2216014

Address:
10225 AUSTIN DR
STE 105
SPRING VALLEY, CA
ZIP 91978
Phone: (858) 648-0755
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INNOVATIVE WELLNESS CLINIC, INC., A NURSING CORPORATION is a family medicine in Spring Valley, CA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. INNOVATIVE WELLNESS CLINIC, INC., A NURSING CORPORATION NPI is 1316535776. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Iwc Primary Care.

The provider's business location address is:

10225 AUSTIN DR
STE 105
SPRING VALLEY, CA
ZIP 91978-521
Phone: (858) 648-0755
Fax: (534) 429-4287

The provider's authorized official is Danielle Alexis Gordon .
The authorized official title is Primary Care Provider and has the following contact phone number (858) 648-0755.

The CLIA number assigned to this NPI record is 05D2216014 - practitioner other with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 12/31/2020 and was last updated on 1/31/2024.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1A49264OTHERCALIFORNIAMEDICAL LICENSE
2NP95010963OTHERCALIFORNIANURSE PRACTITIONER LICENSE NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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