Provider Demographics
NPI:1215394283
Name:CENTER FOR LIVING MEDICAL GROUP INC
Entity Type:Organization
Organization Name:CENTER FOR LIVING MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAKELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-308-9784
Mailing Address - Street 1:4519 ROSEMEAD BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1476
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4519 ROSEMEAD BLVD FL 2
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1476
Practice Address - Country:US
Practice Address - Phone:626-308-9784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty