MEDICARE: MOCEAN LA WELLNESS CORP

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1689412298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOCEAN LA WELLNESS CORP

Provider Business Mailing Address
First Line	:	7551 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-3415
Country	:	US
Telephone Number	:	914-924-9743
Fax Number	:

Provider Business Practice Location Address
First Line	:	7551 W SUNSET BLVD STE 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-3442
Country	:	US
Telephone Number	:	914-924-9743
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	MICHAEL OAKES
Credential	:
Telephone Number	:	914-924-9743

Provider Enumeration Date	:	07/17/2024
Last Update Date	:	07/17/2024

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Directions to “MOCEAN LA WELLNESS CORP ” Practice Location

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