Provider Demographics
NPI:1821704149
Name:ROBERTSON WELLNESS CONCIERGE SERVICES PC
Entity Type:Organization
Organization Name:ROBERTSON WELLNESS CONCIERGE SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAYEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:323-627-1557
Mailing Address - Street 1:150 N ROBERTSON BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2144
Mailing Address - Country:US
Mailing Address - Phone:310-407-0542
Mailing Address - Fax:
Practice Address - Street 1:150 N ROBERTSON BLVD STE 206
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2144
Practice Address - Country:US
Practice Address - Phone:310-407-0542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251F00000XAgenciesHome Infusion
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
95019804OtherNPI
A77410OtherOTHER