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General NPI Number Information
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NPI Number | 1891413936
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Entity Type | Organization
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Legal Business Name | LIVE WELL IPA
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 35400 BOB HOPE DR STE 204
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-1774
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Country | US
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Telephone | 760-567-6546
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Fax |
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Provider Business Mailing Address
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Address Line | 35400 BOB HOPE DR STE 204
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-1774
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Country | US
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Telephone | 760-567-6546
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SUMIT MAHAJAN
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Credential |
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Telephone | 760-567-6545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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