Healthcare Provider Details

I. General information

NPI: 1679755227
Provider Name (Legal Business Name): NEW WELLNESS REHABILITATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 WILSHIRE BLVD SUITE 1000
BEVERLY HILLS CA
90212-2020
US

IV. Provider business mailing address

9701 WILSHIRE BLVD SUITE 1000
BEVERLY HILLS CA
90212-2020
US

V. Phone/Fax

Practice location:
  • Phone: 310-860-6110
  • Fax: 310-861-1462
Mailing address:
  • Phone: 310-860-6110
  • Fax: 310-861-1462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA55508
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19584
License Number StateCA

VIII. Authorized Official

Name: MICHAEL M ASHNIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-860-6110