Individual
SEAN MICHAEL WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1400 N NORMA ST STE 133, RIDGECREST, CA 93555-2577
(760) 499-7406
Mailing address
1441 N ALFORD ST, RIDGECREST, CA 93555-8309
(760) 608-6672
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
07/29/2019
Last updated
10/14/2019
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