# WELLNESS WAVE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124478185
- **Authorized official:** LIZA VISMANOS (PRESIDENT)
- **Authorized official phone:** (310) 920-0991

## Contact information

- **Practice address:** 455 N ROXBURY DR, BEVERLY HILLS, CA 90210-5001
- **Practice address phone:** (310) 920-0991
- **Mailing address:** 455 N ROXBURY DR, BEVERLY HILLS, CA 90210-5001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | CA | Yes |

## Other

- **Enumeration date:** 06/20/2016
- **Last updated:** 06/20/2016