MEDICARE: SALUSIVE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0901X	Public Health & General Preventive Medicine Physician

General Provider Information

NPI Number	:	1780197160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALUSIVE, INC.

Provider Business Mailing Address
First Line	:	5901 VALLEJO ST APT D
Second Line	:
City	:	EMERYVILLE
State	:	CA
Zip	:	94608-2136
Country	:	US
Telephone Number	:	949-922-9562
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 VALLEJO ST APT D
Second Line	:
City	:	EMERYVILLE
State	:	CA
Zip	:	94608-2136
Country	:	US
Telephone Number	:	949-922-9562
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. WALEED MOHSEN
Credential	:
Telephone Number	:	949-922-9562

Provider Enumeration Date	:	11/08/2017
Last Update Date	:	11/08/2017

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