MEDICARE: WHOLE FITNESS 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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1790586576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLE FITNESS INC

Provider Business Mailing Address
First Line	:	17982 LUCERO WAY
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-2624
Country	:	US
Telephone Number	:	808-987-1151
Fax Number	:

Provider Business Practice Location Address
First Line	:	17982 LUCERO WAY
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-2624
Country	:	US
Telephone Number	:	808-987-1151
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL R RUSSO
Credential	:	MS, CPSS
Telephone Number	:	808-987-1511

Provider Enumeration Date	:	03/19/2025
Last Update Date	:	09/11/2025

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Directions to “WHOLE FITNESS INC ” Practice Location

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