Healthcare Provider Details

I. General information

NPI: 1457274342
Provider Name (Legal Business Name): FIX WELLNESS LOUNGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 ARTESIA BLVD
HERMOSA BEACH CA
90254-2707
US

IV. Provider business mailing address

960 ARTESIA BLVD
HERMOSA BEACH CA
90254-2707
US

V. Phone/Fax

Practice location:
  • Phone: 585-746-0133
  • Fax:
Mailing address:
  • Phone:
  • 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: AMY CONFER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 585-746-0133