=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245043512
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIVE WELL COLLECTIVE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2025
-----------------------------------------------------
Last Update Date | 01/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 742 GENEVIEVE ST STE B
-----------------------------------------------------
City | SOLANA BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92075-2060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-263-5955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 742 GENEVIEVE ST STE B
-----------------------------------------------------
City | SOLANA BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92075-2060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-263-5955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTIONER/ FOUNDER
-----------------------------------------------------
Name | MEGAN WELL BENDINELLI
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 858-344-8249
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------