MEDICARE: SOUL ALIGNED HEALTH & WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1225881543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUL ALIGNED HEALTH & WELLNESS LLC

Provider Business Mailing Address
First Line	:	1203 1/2 N EL CENTRO AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-1705
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1203 1/2 N EL CENTRO AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-1705
Country	:	US
Telephone Number	:	570-780-0069
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAUREN WALEGA
Credential	:	RD
Telephone Number	:	570-780-0069

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	04/08/2024

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