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General NPI Number Information
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NPI Number | 1912278664
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Entity Type | Organization
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Legal Business Name | CENTER FOR WELLNESS
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 420 N MONTEBELLO BLVD 300
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City | MONTEBELLO
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State | CA
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Zip | 90640-4268
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Country | US
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Telephone | 323-726-6289
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Fax | 323-726-6767
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Provider Business Mailing Address
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Address Line | 420 N MONTEBELLO BLVD 300
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City | MONTEBELLO
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State | CA
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Zip | 90640-4268
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Country | US
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Telephone | 323-726-6289
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Fax | 323-726-6767
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Authorized Official
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Title or Position | PRACTITIONER / PHYSICIAN
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Name | MR. JORGE L MORENO
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Credential | D.O.
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Telephone | 323-726-6289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175L00000X
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Taxonomy Name | Homeopath
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 204R00000X
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Taxonomy Name | Electrodiagnostic Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 20A6911
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License Number State | CA
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