Healthcare Provider Details

I. General information

NPI: 1558992982
Provider Name (Legal Business Name): DR FUSCALDOS HEALTH AND WELLNESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7537 LAUREL CANYON BLVD
NORTH HOLLYWOOD CA
91605
US

IV. Provider business mailing address

7537 LAUREL CANYON BLVD
NORTH HOLLYWOOD CA
91605
US

V. Phone/Fax

Practice location:
  • Phone: 818-858-0211
  • Fax:
Mailing address:
  • Phone: 818-962-5505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FRANCISCO B FUSCALDO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 818-858-0211