Provider Demographics
NPI:1053311332
Name:GOLD WELLNESS INC
Entity Type:Organization
Organization Name:GOLD WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:323-939-7050
Mailing Address - Street 1:6221 WILSHIRE BLVD.,
Mailing Address - Street 2:#616
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048
Mailing Address - Country:US
Mailing Address - Phone:323-939-7050
Mailing Address - Fax:323-939-7056
Practice Address - Street 1:6221 WILSHIRE BLVD
Practice Address - Street 2:#616
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5201
Practice Address - Country:US
Practice Address - Phone:323-939-7050
Practice Address - Fax:323-939-7056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25860225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P93594Medicare UPIN
CAWPT25860AMedicare ID - Type Unspecified