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Organization
WELLNESS WAVE LLC
Active
Organization
WELLNESS WAVE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIZA VISMANOS (PRESIDENT)
(310) 920-0991
Entity
Organization
Contact information
Practice address
455 N ROXBURY DR, BEVERLY HILLS, CA 90210-5001
(310) 920-0991
Mailing address
455 N ROXBURY DR, BEVERLY HILLS, CA 90210-5001
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
CA
Other
Enumeration date
06/20/2016
Last updated
06/20/2016
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