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Organization
WELL MEDICAL, A PROFESSIONAL CORPORATION
Active
Organization
WELL MEDICAL, A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ILDAR FAZULYANOV (CHIEF OPERATING OFFICER)
(310) 384-0970
Entity
Organization
Contact information
Practice address
929 COLORADO AVE, SANTA MONICA, CA 90401-2716
(424) 221-5012
Mailing address
2280 SAWTELLE BLVD. # 101, LOS ANGELES, CA 90064
(310) 384-0970
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/31/2016
Last updated
03/08/2021
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