Provider Demographics
NPI:1619305018
Name:5150FITNESS
Entity Type:Organization
Organization Name:5150FITNESS
Other - Org Name:MADE IN LA FITNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MARGO
Authorized Official - Last Name:LAWENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-350-2276
Mailing Address - Street 1:1710 N MCCADDEN PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-4603
Mailing Address - Country:US
Mailing Address - Phone:323-461-1990
Mailing Address - Fax:323-461-1995
Practice Address - Street 1:1710 N MCCADDEN PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-4603
Practice Address - Country:US
Practice Address - Phone:323-461-1990
Practice Address - Fax:323-461-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty