| Wave Wellness Clinic Professional Corporation | |
|
4407 Manchester Ave Ste 101 Encinitas CA 92024-4941 | |
| (760) 652-6800 | |
| (760) 274-6165 |
| Full Name | Wave Wellness Clinic Professional Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 4407 Manchester Ave Ste 101, Encinitas, California |
| Authorized Official Name and Position | Emma Dorantes (OFFICE MANAGER) |
| Authorized Official Contact | 7604587539 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wave Wellness Clinic Professional Corporation 4401 Manchester Ave Ste 106 Encinitas CA 92024-4938 Ph: (760) 753-0220 | Wave Wellness Clinic Professional Corporation 4407 Manchester Ave Ste 101 Encinitas CA 92024-4941 Ph: (760) 652-6800 |
| NPI Number | 1417774399 |
|---|---|
| Provider Enumeration Date | 09/23/2024 |
| Last Update Date | 11/20/2024 |
| Certification Date | 11/20/2024 |
| Medicare PECOS PAC ID | 2163957648 |
|---|---|
| Medicare Enrollment ID | O20241120002442 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417774399 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Aimee J Warren |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093974222 PECOS PAC ID: 1254504350 Enrollment ID: I20111107000360 |
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