Organization
360 WELLNESS SOLUTIONS, LLC
Active
Other names
360 Wellness Solutions Mobile and Telehealth Services
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHERINE JOSEPHINE SULLIVAN PHD, PT (PRESIDENT)
(760) 832-8025
Entity
Organization
Contact information
Practice address
194 LOCH LOMOND RD, RANCHO MIRAGE, CA 92270-5600
(760) 832-8025
(760) 764-4010
Mailing address
194 LOCH LOMOND RD, RANCHO MIRAGE, CA 92270-5600
(760) 832-8025
(760) 764-4010
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285033878
CASH
CA
01
—
1447773825
ANTHEM
CA
Enumeration date
07/18/2017
Last updated
08/24/2022
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