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General NPI Number Information
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NPI Number | 1437483419
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Entity Type | Organization
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Legal Business Name | TRINITY HEALTH AND WELLNESS MEDICAL GROUP
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Dates
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Enumeration Date | 09/24/2009
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Last Update Date | 09/24/2009
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Provider Practice Location Address
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Address Line | 7231 SANTA MONICA BLVD
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90046-6724
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Country | US
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Telephone | 323-874-1200
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Fax | 323-874-1222
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Provider Business Mailing Address
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Address Line | 7231 SANTA MONICA BLVD
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90046-6724
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Country | US
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Telephone | 323-874-1200
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Fax | 323-874-1222
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MS. NOELLE ELYSE REID
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Credential | M.D.
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Telephone | 323-874-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | A100360
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License Number State | CA
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