MEDICARE: WELLBEING HOLISTIC MEDICINE 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	207Q00000X	Family Medicine Physician
2	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1972148369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLBEING HOLISTIC MEDICINE INC

Provider Business Mailing Address
First Line	:	230 N MARYLAND AVE STE 110
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-4283
Country	:	US
Telephone Number	:	818-551-0464
Fax Number	:	818-551-0462

Provider Business Practice Location Address
First Line	:	5841 BELLFLOWER BLVD
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90713-1057
Country	:	US
Telephone Number	:	818-551-0464
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. CRISTAL DAWN SPELLER
Credential	:	MD MPH
Telephone Number	:	818-551-0464

Provider Enumeration Date	:	11/09/2019
Last Update Date	:	06/30/2020

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