Healthcare Provider Details

I. General information

NPI: 1205746393
Provider Name (Legal Business Name): CONCIERGE HEALTH & WELLNESS MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3868 W CARSON ST STE 110
TORRANCE CA
90503-6706
US

IV. Provider business mailing address

3868 W CARSON ST STE 110
TORRANCE CA
90503-6706
US

V. Phone/Fax

Practice location:
  • Phone: 617-359-6110
  • Fax:
Mailing address:
  • Phone: 617-359-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARON JAIME
Title or Position: CEO
Credential:
Phone: 617-359-6110