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General NPI Number Information
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NPI Number | 1649080136
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Entity Type | Organization
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Legal Business Name | WELLNESS WIZARD MEDICAL GROUP INC
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 4318 W VICTORY BLVD
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City | BURBANK
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State | CA
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Zip | 91505-1334
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Country | US
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Telephone | 818-275-7554
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Fax |
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Provider Business Mailing Address
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Address Line | 4318 W VICTORY BLVD
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City | BURBANK
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State | CA
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Zip | 91505-1334
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Country | US
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Telephone | 818-275-7554
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERIC XIAOFENG LU
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Credential | MD
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Telephone | 415-960-5393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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