MEDICARE: TOTAL LIFE WELLNESS

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	302R00000X	Health Maintenance Organization
2	133NN1002X	Nutrition Education Nutritionist

General Provider Information

NPI Number	:	1851759757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL LIFE WELLNESS

Provider Business Mailing Address
First Line	:	1533 LINCOLN WAY APT 2
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-1923
Country	:	US
Telephone Number	:	301-752-1425
Fax Number	:

Provider Business Practice Location Address
First Line	:	1533 LINCOLN WAY APT 2
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-1923
Country	:	US
Telephone Number	:	301-752-1425
Fax Number	:

Authorized Official
Title or Position	:	NUTRITIONIST
Name	:	ROSE ANN M HAFT
Credential	:	MSNIH, CHHC
Telephone Number	:	301-752-1425

Provider Enumeration Date	:	02/05/2016
Last Update Date	:	02/05/2016

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Directions to “TOTAL LIFE WELLNESS ” Practice Location

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