Provider Demographics
NPI:1447616198
Name:BEVERLY HILLS WELLNESS PHYSICIANS CORP
Entity Type:Organization
Organization Name:BEVERLY HILLS WELLNESS PHYSICIANS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOODLOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-518-5980
Mailing Address - Street 1:1703 N AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-1432
Mailing Address - Country:US
Mailing Address - Phone:818-518-5980
Mailing Address - Fax:818-337-2049
Practice Address - Street 1:1703 N AVALON BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-1432
Practice Address - Country:US
Practice Address - Phone:818-518-5980
Practice Address - Fax:818-337-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy