Healthcare Provider Details

I. General information

NPI: 1649141706
Provider Name (Legal Business Name): WELLNESS OF MIND BODY AND SPIRIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 E MISSION RD STE C
SAN GABRIEL CA
91776-2761
US

IV. Provider business mailing address

418 E LAS TUNAS DR UNIT 3G
SAN GABRIEL CA
91776-5506
US

V. Phone/Fax

Practice location:
  • Phone: 626-571-8660
  • Fax: 844-270-2240
Mailing address:
  • Phone: 626-571-8660
  • Fax: 844-270-2240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ANA HUA
Title or Position: ELECTROLOGIST/MANAGER
Credential:
Phone: 626-571-8660