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General NPI Number Information
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NPI Number | 1265726376
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Entity Type | Organization
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Legal Business Name | TRIGEM WELLNESS MD INC
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5572 SOUTH ST
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City | LAKEWOOD
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State | CA
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Zip | 90713-1302
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Country | US
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Telephone | 562-275-3542
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Fax | 562-275-3614
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Provider Business Mailing Address
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Address Line | 5572 SOUTH ST
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City | LAKEWOOD
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State | CA
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Zip | 90713-1302
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Country | US
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Telephone | 562-275-3542
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Fax | 562-275-3614
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MOHSIN ALI
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Credential | MD
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Telephone | 562-275-3542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 170100000X
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Taxonomy Name | Ph.D. Medical Genetics
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License Number |
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License Number State | CA
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