Provider Demographics
NPI:1841576535
Name:GOOGLE WELLNESS CENTER, B40
Entity Type:Organization
Organization Name:GOOGLE WELLNESS CENTER, B40
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-253-3313
Mailing Address - Street 1:1600 AMPHITHEATRE PKWY
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-1351
Mailing Address - Country:US
Mailing Address - Phone:650-253-3313
Mailing Address - Fax:650-362-2302
Practice Address - Street 1:1600 AMPHITHEATRE PKWY
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-1351
Practice Address - Country:US
Practice Address - Phone:650-253-3313
Practice Address - Fax:650-362-2302
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHS HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 73520332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site