Provider Demographics
NPI:1821204868
Name:SANTA MONICA WELLNESS CENTER CORP
Entity Type:Organization
Organization Name:SANTA MONICA WELLNESS CENTER CORP
Other - Org Name:SANTA MONICA WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-451-7170
Mailing Address - Street 1:1137 SECOND ST
Mailing Address - Street 2:STE 116
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5074
Mailing Address - Country:US
Mailing Address - Phone:310-451-7170
Mailing Address - Fax:310-451-4044
Practice Address - Street 1:1137 SECOND ST
Practice Address - Street 2:STE 116
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5074
Practice Address - Country:US
Practice Address - Phone:310-451-7170
Practice Address - Fax:310-451-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty