Organization
WANDA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. WANDA JEAN SMITH LVN (LVN)
(909) 496-2440
Entity
Organization
Contact information
Practice address
3730 FERNWOOD AVE, RIALTO, CA 92377-2724
(909) 823-3703
(909) 823-3703
Mailing address
3730 FERNWOOD AVE, RIALTO, CA 92377-2724
(909) 823-3703
(909) 823-3703
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
320700000X
CA
Other
Enumeration date
07/09/2008
Last updated
09/06/2023
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