Provider Demographics
NPI:1184922429
Name:THE WELLNESS INSTITUTE OF AMERICA, LLC
Entity type:Organization
Organization Name:THE WELLNESS INSTITUTE OF AMERICA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:SKLAR
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:619-265-0291
Mailing Address - Street 1:2425 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3744
Mailing Address - Country:US
Mailing Address - Phone:619-265-0291
Mailing Address - Fax:619-265-0290
Practice Address - Street 1:2425 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3744
Practice Address - Country:US
Practice Address - Phone:619-265-0291
Practice Address - Fax:619-265-0290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9332171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty