Healthcare Provider Details

I. General information

NPI: 1316118789
Provider Name (Legal Business Name): WISE & HEALTHY AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1527 4TH ST
SANTA MONICA CA
90401-2358
US

V. Phone/Fax

Practice location:
  • Phone: 310-394-9871
  • Fax: 310-395-0863
Mailing address:
  • Phone: 310-394-9871
  • Fax: 310-576-2449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MOLLY DAVIES
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 310-394-9871