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General NPI Number Information
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NPI Number | 1780190983
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Entity Type | Organization
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Legal Business Name | THRIVE FULL BODY WELLNESS
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Dates
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Enumeration Date | 12/26/2017
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Last Update Date | 12/26/2017
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Provider Practice Location Address
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Address Line | 4959 KATELLA AVE STE C
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City | CYPRESS
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State | CA
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Zip | 90720-2747
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Country | US
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Telephone | 714-952-9335
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Fax | 714-952-9331
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Provider Business Mailing Address
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Address Line | 4959 KATELLA AVE STE C
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City | CYPRESS
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State | CA
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Zip | 90720-2747
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Country | US
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Telephone | 714-952-9335
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Fax | 714-952-9331
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Authorized Official
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Title or Position | CEO
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Name | SETH CAMHI
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Credential | MD
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Telephone | 714-952-9335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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