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General NPI Number Information
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NPI Number | 1821539677
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Entity Type | Organization
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Legal Business Name | MONARCH WELLNESS GROUP
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 3122 SANTA MONICA BLVD SUITE 102
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City | SANTA MONICA
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State | CA
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Zip | 90404-2533
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Country | US
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Telephone | 424-610-6814
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Fax |
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Provider Business Mailing Address
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Address Line | 11870 SANTA MONICA BLVD SUITE 106570
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City | LOS ANGELES
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State | CA
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Zip | 90025-2276
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Country | US
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Telephone | 424-610-6814
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIEDRA MANNS
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Credential | DPT
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Telephone | 424-610-6814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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