Provider Demographics
NPI:1609299320
Name:SUPERIOR HEALTH & WELLNESS MEDICAL GROUP A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SUPERIOR HEALTH & WELLNESS MEDICAL GROUP A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:GERMANOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-696-7769
Mailing Address - Street 1:22224 LA PALMA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3819
Mailing Address - Country:US
Mailing Address - Phone:714-696-7769
Mailing Address - Fax:714-696-7949
Practice Address - Street 1:22224 LA PALMA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-3819
Practice Address - Country:US
Practice Address - Phone:714-696-7769
Practice Address - Fax:714-696-7949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12144261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care