Well Medical, A Professional Corporation
Nurse Practitioner in Santa Monica, CA. Organization (NPI-2).
NPI number1699123737
StatusActive
Last updated in NPPESMar 8, 2021
Details
- NPI
- 1699123737
- Entity type
- Organization (NPI-2)
- Legal business name
- Well Medical, A Professional Corporation
- Organization subpart
- No
- Enumeration date
- May 31, 2016
- Certification date
- Mar 8, 2021
- Last updated
- Mar 8, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363L00000X | Nurse Practitioner | – | – | Yes |
| 225100000X | Physical Therapist | – | – |
Practice location
929 Colorado AveSanta Monica, CA 90401-2716
Phone 424-221-5012
Mailing address
2280 Sawtelle Blvd. # 101Los Angeles, CA 90064
Phone 310-384-0970
Authorized official
Ildar Fazulyanov
Chief Operating Officer
3103840970
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