Healthcare Provider Details

I. General information

NPI: 1154200475
Provider Name (Legal Business Name): ELEVE CONCIERGE WELLNESS, A PROFESSIOINAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 STONEHILL LN
LOS ANGELES CA
90049-1413
US

IV. Provider business mailing address

916 STONEHILL LN
LOS ANGELES CA
90049-1413
US

V. Phone/Fax

Practice location:
  • Phone: 310-633-1907
  • Fax: 310-633-1907
Mailing address:
  • Phone: 310-633-1907
  • Fax: 310-633-1907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL

VIII. Authorized Official

Name: CAITLIN ROSE BOTHWELL
Title or Position: CEO
Credential:
Phone: 310-633-1907