Healthcare Provider Details

I. General information

NPI: 1477281897
Provider Name (Legal Business Name): WELLNESS TELEHEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 SHAW AVE # 343
CLOVIS CA
93611-4072
US

IV. Provider business mailing address

1420 SHAW AVE # 343
CLOVIS CA
93611-4072
US

V. Phone/Fax

Practice location:
  • Phone: 559-558-2415
  • Fax:
Mailing address:
  • Phone: 559-558-2415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEL LO
Title or Position: FOUNDER
Credential:
Phone: 559-558-2415