Organization
WAVE WELLNESS CLINIC PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMMA DORANTES (OFFICE MANAGER)
(760) 458-7539
Entity
Organization
Contact information
Practice address
4407 MANCHESTER AVE STE 101, ENCINITAS, CA 92024-4941
(760) 652-6800
(760) 274-6165
Mailing address
4401 MANCHESTER AVE STE 106, ENCINITAS, CA 92024-4938
(760) 753-0220
(760) 753-2639
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
09/23/2024
Last updated
11/20/2024
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