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General NPI Number Information
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NPI Number | 1437965381
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Entity Type | Organization
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Legal Business Name | QUALITY OF LIFE MEDICINE PC
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 11400 W OLYMPIC BLVD STE 200
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City | LOS ANGELES
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State | CA
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Zip | 90064
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Country | US
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Telephone | 609-933-1270
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 LINCOLN BLVD # 1232
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City | VENICE
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State | CA
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Zip | 90291-3503
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Country | US
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Telephone | 609-933-1270
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALICIA ROLDAN
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Credential | DO
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Telephone | 609-933-1270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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