Provider Demographics
NPI:1306220538
Name:NEW MILLENNIUM INSTITUTE OF WELLNESS, INC.
Entity Type:Organization
Organization Name:NEW MILLENNIUM INSTITUTE OF WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:310-670-9344
Mailing Address - Street 1:5601 W SLAUSON AVE
Mailing Address - Street 2:SUITE 234
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6582
Mailing Address - Country:US
Mailing Address - Phone:310-670-9344
Mailing Address - Fax:310-670-9376
Practice Address - Street 1:5601 W SLAUSON AVE
Practice Address - Street 2:SUITE 234
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6582
Practice Address - Country:US
Practice Address - Phone:310-670-9344
Practice Address - Fax:310-670-9376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA393487261Q00000X
CA23007261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1588866149OtherNPI
CA1588866149OtherNPI