Healthcare Provider Details

I. General information

NPI: 1528827466
Provider Name (Legal Business Name): PINNACLE WELL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3756 SANTA ROSALIA DR STE 100
LOS ANGELES CA
90008-3617
US

IV. Provider business mailing address

1171 TRAPPERS CT
THE VILLAGES FL
32163-2746
US

V. Phone/Fax

Practice location:
  • Phone: 323-596-3530
  • Fax:
Mailing address:
  • Phone: 614-316-6166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARON LOGAN
Title or Position: COO
Credential:
Phone: 614-316-6166