Organization
LIVE WELL IPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUMIT MAHAJAN (CEO)
(760) 567-6545
Entity
Organization
Contact information
Practice address
35400 BOB HOPE DR STE 204, RANCHO MIRAGE, CA 92270-1774
(760) 567-6546
Mailing address
35400 BOB HOPE DR STE 204, RANCHO MIRAGE, CA 92270-1774
(760) 567-6546
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
08/15/2022
Last updated
08/15/2022
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