Basic Information
| Provider Information | |||||||||
| NPI: | 1528661782 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH & WELLNESS 365 LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2404 KINSELLA WAY | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957479178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619296244 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2404 KINSELLA WAY | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957479574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619296244 | ||||||||
| FaxNumber: | 9183988932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2020 | ||||||||
| LastUpdateDate: | 11/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | GEORGE | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | MEKELLA | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 9168270463 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DNP, FNP-BC, CDCES | ||||||||
| NPICertificationDate: | 11/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133NN1002X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.