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General NPI Number Information
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NPI Number | 1538354519
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Entity Type | Organization
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Legal Business Name | STUDIO CITY WELLNESS CENTER
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 4789 VINELAND AVE
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91602-3518
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Country | US
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Telephone | 818-761-1662
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Fax | 818-761-0482
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Provider Business Mailing Address
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Address Line | 4789 VINELAND AVE
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91602-3518
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Country | US
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Telephone | 818-761-1662
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Fax | 818-761-0482
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CHARLES E LAW II
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Credential | M.D.
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Telephone | 818-761-1662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | G20667
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License Number State | CA
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