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General NPI Number Information
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NPI Number | 1740178953
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Entity Type | Organization
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Legal Business Name | AERIS MOBILE WELLNESS LLC
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Dates
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Enumeration Date | 06/25/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 15060 VICTORY BLVD UNIT 204
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City | VAN NUYS
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State | CA
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Zip | 91411-1829
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Country | US
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Telephone | 805-552-6753
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Fax |
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Provider Business Mailing Address
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Address Line | 6221 VAN NUYS BLVD # 659
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City | VAN NUYS
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State | CA
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Zip | 91401-2710
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Country | US
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Telephone | 805-552-6753
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELENA GONZALEZ
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Credential | CPT 1
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Telephone | 818-919-1666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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