# HEALTHY SOURCE RX INC

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

## Provider details

- **NPI number:** 1366002370
- **Authorized official:** TIMOTHY DAVIS (OWNER)
- **Authorized official phone:** (310) 574-2777

## Contact information

- **Practice address:** 2801 WILSHIRE BLVD STE A, SANTA MONICA, CA 90403-4801
- **Practice address phone:** (310) 574-2777
- **Mailing address:** 1112 MONTANA AVE STE 900, SANTA MONICA, CA 90403-1652

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/20/2019
- **Last updated:** 06/20/2019