Provider Demographics
NPI:1477281897
Name:WELLNESS TELEHEALTH LLC
Entity Type:Organization
Organization Name:WELLNESS TELEHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-558-2415
Mailing Address - Street 1:1420 SHAW AVE # 343
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4072
Mailing Address - Country:US
Mailing Address - Phone:559-558-2415
Mailing Address - Fax:
Practice Address - Street 1:1420 SHAW AVE # 343
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-4072
Practice Address - Country:US
Practice Address - Phone:559-558-2415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA6167727OtherDRIVING LICENSE