Organization
POWERSMD WELLNESS MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS POWERS MD (OWNER)
(714) 843-0400
Entity
Organization
Contact information
Practice address
428 MAIN ST, SUITE 101, HUNTINGTON BEACH, CA 92648-8142
(714) 843-0400
(714) 969-4001
Mailing address
428 MAIN ST, SUITE 101, HUNTINGTON BEACH, CA 92648-8142
(714) 843-0400
(714) 969-4001
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
G15640
CA
208D00000X
General Practice Physician
Primary
G15640
CA
208VP0000X
Pain Medicine Physician
G15640
CA
208VP0014X
Interventional Pain Medicine Physician
G15640
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A119702
MEDICAL LICENSE
CA
01
—
G15640
MEDICAL LICENSE
CA
Enumeration date
08/07/2013
Last updated
09/23/2013
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