MEDICARE: WHOLE LIFE MEDICAL GROUP INC.

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	174400000X	Specialist	38144	CA

General Provider Information

NPI Number	:	1861673931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLE LIFE MEDICAL GROUP INC.

Provider Business Mailing Address
First Line	:	800 S PACIFIC COAST HWY STE 6B
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-4772
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 S PACIFIC COAST HWY STE 6B
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-4772
Country	:	US
Telephone Number	:	310-543-7755
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN JAROCINSKI
Credential	:
Telephone Number	:	310-543-7755

Provider Enumeration Date	:	11/17/2007
Last Update Date	:	11/17/2007

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