Healthcare Provider Details

I. General information

NPI: 1437483419
Provider Name (Legal Business Name): TRINITY HEALTH AND WELLNESS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7231 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90046-6724
US

IV. Provider business mailing address

7231 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90046-6724
US

V. Phone/Fax

Practice location:
  • Phone: 323-874-1200
  • Fax: 323-874-1222
Mailing address:
  • Phone: 323-874-1200
  • Fax: 323-874-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberA100360
License Number StateCA

VIII. Authorized Official

Name: MS. NOELLE ELYSE REID
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 323-874-1200