MEDICARE: GOOGLE WELLNESS CENTER, B48

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	332900000X	Non-Pharmacy Dispensing Site	A 73520	CA

General Provider Information

NPI Number	:	1336425867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOGLE WELLNESS CENTER, B48

Provider Business Mailing Address
First Line	:	1010 JOAQUIN RD
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94043-1242
Country	:	US
Telephone Number	:	650-214-6369
Fax Number	:	650-253-8476

Provider Business Practice Location Address
First Line	:	1010 JOAQUIN RD
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94043-1242
Country	:	US
Telephone Number	:	650-214-6369
Fax Number	:	650-253-8476

Authorized Official
Title or Position	:	MANAGER
Name	:	DAVID LEES
Credential	:
Telephone Number	:	408-348-4214

Provider Enumeration Date	:	10/28/2011
Last Update Date	:	10/28/2011

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