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General NPI Number Information
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NPI Number | 1811766942
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Entity Type | Organization
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Legal Business Name | MILLENNIUM HEALTH GROUP, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 12/29/2023
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Last Update Date | 12/29/2023
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Provider Practice Location Address
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Address Line | 8641 WILSHIRE BLVD STE 100
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2919
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Country | US
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Telephone | 310-360-5917
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Fax |
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Provider Business Mailing Address
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Address Line | 8549 WILSHIRE BLVD STE 1248
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3104
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JUSTIN WIESNER
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Credential |
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Telephone | 424-285-5385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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