MEDICARE: HEALTH & WELLNESS 365 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	133NN1002X	Nutrition Education Nutritionist
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1528661782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH & WELLNESS 365 LLC

Provider Business Mailing Address
First Line	:	2404 KINSELLA WAY
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95747-9178
Country	:	US
Telephone Number	:	561-929-6244
Fax Number	:

Provider Business Practice Location Address
First Line	:	2404 KINSELLA WAY
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95747-9574
Country	:	US
Telephone Number	:	561-929-6244
Fax Number	:	918-398-8932

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	DR. MELISSA MEKELLA GEORGE
Credential	:	DNP, FNP-BC, CDCES
Telephone Number	:	916-827-0463

Provider Enumeration Date	:	11/19/2020
Last Update Date	:	11/19/2020

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