Provider Demographics
NPI:1861639700
Name:LIVE WELL NATUROPATHIC CLINIC, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LIVE WELL NATUROPATHIC CLINIC, A PROFESSIONAL CORPORATION
Other - Org Name:LIVE WELL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:N
Authorized Official - Last Name:FUNG
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:213-268-8884
Mailing Address - Street 1:78900 AVENUE 47
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-7168
Mailing Address - Country:US
Mailing Address - Phone:760-771-5970
Mailing Address - Fax:760-771-5982
Practice Address - Street 1:78900 AVENUE 47 STE 102
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2070
Practice Address - Country:US
Practice Address - Phone:760-771-5970
Practice Address - Fax:760-771-5982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA331175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty