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General NPI Number Information
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NPI Number | 1851759070
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Entity Type | Organization
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Legal Business Name | SHORELINE WELLNESS MULTI
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Dates
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Enumeration Date | 02/02/2016
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Last Update Date | 02/02/2016
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Provider Practice Location Address
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Address Line | 1360 W 6TH ST STE 165
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City | SAN PEDRO
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State | CA
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Zip | 90732-3540
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Country | US
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Telephone | 424-287-5555
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Fax | 310-872-5508
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Provider Business Mailing Address
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Address Line | 1360 W 6TH ST STE 165
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City | SAN PEDRO
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State | CA
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Zip | 90732-3540
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Country | US
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Telephone | 424-287-5555
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Fax | 310-872-5508
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MADHU KATAKIA
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Credential | M.D.
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Telephone | 424-287-5555
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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 | CA
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