Provider Demographics
NPI:1548386006
Name:WALNUT CREEK WELLNESS CENTER
Entity type:Organization
Organization Name:WALNUT CREEK WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DEALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-979-9292
Mailing Address - Street 1:1776 YGNACIO VALLEY RD STE 208
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3125
Mailing Address - Country:US
Mailing Address - Phone:925-979-9292
Mailing Address - Fax:925-979-9222
Practice Address - Street 1:1776 YGNACIO VALLEY RD STE 208
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3125
Practice Address - Country:US
Practice Address - Phone:925-979-9292
Practice Address - Fax:925-979-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF90918Medicare UPIN
CA00G861240Medicare ID - Type UnspecifiedPAUL H. KIM
CAH66606Medicare UPIN
CA00A720300Medicare ID - Type UnspecifiedCATHERINE M. WANG