# POWERSMD WELLNESS MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740612134
- **Authorized official:** DR. THOMAS POWERS MD (OWNER)
- **Authorized official phone:** (714) 843-0400

## Contact information

- **Practice address:** 428 MAIN ST, SUITE 101, HUNTINGTON BEACH, CA 92648-8142
- **Practice address phone:** (714) 843-0400
- **Practice address fax:** (714) 969-4001
- **Mailing address:** 428 MAIN ST, SUITE 101, HUNTINGTON BEACH, CA 92648-8142
- **Mailing address phone:** (714) 843-0400
- **Mailing address fax:** (714) 969-4001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | G15640 | CA | — |
| 208D00000X | General Practice Physician | G15640 | CA | Yes |
| 208VP0000X | Pain Medicine Physician | G15640 | CA | — |
| 208VP0014X | Interventional Pain Medicine Physician | G15640 | CA | — |

## Other

- **Enumeration date:** 08/07/2013
- **Last updated:** 09/23/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | A119702 | MEDICAL LICENSE | CA |
| 01 | — | G15640 | MEDICAL LICENSE | CA |