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Organization
LIVEWELL MEDICAL CLINIC INC
Active
Organization
LIVEWELL MEDICAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA LUISA OSMONA MD (PRESIDENT OWNER)
(650) 873-3338
Entity
Organization
Contact information
Practice address
1150 EL CAMINO REAL, #225, SAN BRUNO, CA 94066
(650) 873-3338
(650) 873-3308
Mailing address
5528 PACHECO BLVD, STE A, PACHECO, CA 94553
(925) 363-8170
(925) 363-4995
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
A78723
CA
208000000X
Pediatrics Physician
Primary
G78328
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0101840
—
CA
Enumeration date
09/28/2006
Last updated
08/22/2020
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