=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821667718
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHEZFIT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2021
-----------------------------------------------------
Last Update Date | 06/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19009 S LAUREL PARK RD SPC 363
-----------------------------------------------------
City | RANCHO DOMINGUEZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90220-6060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-364-6712
-----------------------------------------------------
Fax | 800-364-6712
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4681
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90711-4681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-364-6712
-----------------------------------------------------
Fax | 800-364-6712
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | RACHAEL E HULTZ
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 800-364-6712
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------