Healthcare Provider Details

I. General information

NPI: 1134399165
Provider Name (Legal Business Name): WISE &HEALTHY AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 4TH ST 3RD FLOOR
SANTA MONICA CA
90401-2358
US

IV. Provider business mailing address

1527 4TH ST 2ND FLOOR
SANTA MONICA CA
90401-2358
US

V. Phone/Fax

Practice location:
  • Phone: 310-394-9871
  • Fax: 310-576-2499
Mailing address:
  • Phone: 310-394-9871
  • Fax: 310-576-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. GRACE CHENG BRAUN
Title or Position: PRESIDENT & CEO
Credential:
Phone: 310-394-9871