Healthcare Provider Details

I. General information

NPI: 1922884907
Provider Name (Legal Business Name): PCH WELLNESS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12732 W WASHINGTON BLVD STE C
LOS ANGELES CA
90066-2378
US

IV. Provider business mailing address

2400 WALNUT AVE APT 6
VENICE CA
90291-5956
US

V. Phone/Fax

Practice location:
  • Phone: 310-463-3347
  • Fax:
Mailing address:
  • Phone: 310-463-3347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHAUCHABAR BRUHWILER
Title or Position: CEO
Credential:
Phone: 310-463-3347