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Organization
INNOVATIVE WELLNESS CLINIC, INC., A NURSING CORPORATION
Active
Organization
INNOVATIVE WELLNESS CLINIC, INC., A NURSING CORPORATION
Active
Other names
IWC Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE ALEXIS GORDON (PRIMARY CARE PROVIDER)
(858) 648-0755
Entity
Organization
Contact information
Practice address
10225 AUSTIN DR, STE 105, SPRING VALLEY, CA 91978-1521
(858) 648-0755
(534) 429-4287
Mailing address
750 OTAY LAKES RD # 111, CHULA VISTA, CA 91910-6915
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A49264
MEDICAL LICENSE
CA
01
—
NP95010963
NURSE PRACTITIONER LICENSE NUMBER
CA
Enumeration date
12/31/2020
Last updated
01/31/2024
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