Healthcare Provider Details

I. General information

NPI: 1720299308
Provider Name (Legal Business Name): WHOLE CHILD WELLNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 EL CAMINO REAL SUITE 101
BELMONT CA
94002-3948
US

IV. Provider business mailing address

1601 EL CAMINO REAL SUITE 101
BELMONT CA
94002-3948
US

V. Phone/Fax

Practice location:
  • Phone: 650-595-5437
  • Fax: 650-595-5438
Mailing address:
  • Phone: 650-595-5437
  • Fax: 650-595-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA68766
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA64193
License Number StateCA

VIII. Authorized Official

Name: DR. ELISA SONG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 650-595-5437