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General NPI Number Information
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NPI Number | 1861923310
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Entity Type | Organization
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Legal Business Name | MEN'S HEALTH AND WELLNESS CENTER USA PC
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 11900 W OLYMPIC BLVD 540
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City | LOS ANGELES
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State | CA
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Zip | 90064-1151
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Country | US
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Telephone | 310-820-1133
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Fax | 310-820-2233
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Provider Business Mailing Address
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Address Line | 23275 S POINTE DR
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1474
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Country | US
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Telephone | 615-562-4048
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF COMPLIANCE
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Name | MRS. JOAN SIMPSON
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Credential |
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Telephone | 615-562-4048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | C50947
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License Number State | CA
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