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Organization
WELLNESS SOLUTION MEDICAL GROUP INC
Active
Organization
WELLNESS SOLUTION MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN KEITH GAMBLE M.D. (PRESIDENT)
(818) 487-1795
Entity
Organization
Contact information
Practice address
6719 GREENBUSH AVE, VALLEY GLEN, CA 91401-1204
(818) 487-1795
Mailing address
12115 MAGNOLIA BLVD # 14, N HOLLYWOOD, CA 91607-2609
(818) 487-1795
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A76121
CA MEDICAL BOARD
CA
Enumeration date
08/13/2019
Last updated
09/22/2021
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