PRIME WELLNESS COMMUNITY HEALTH CENTER NPI 1083251532

NPI Information

PRIME WELLNESS COMMUNITY HEALTH CENTER is a community health clinic center in Los Angeles, CA. PRIME WELLNESS COMMUNITY HEALTH CENTER NPI is 1083251532. The provider is registered as an organization entity type.

The provider's business location address is:

8610 S SEPULVEDA BLVD STE 104
LOS ANGELES, CA
ZIP 90045-009
Phone: (310) 659-7867
Fax: (310) 878-2118

The provider's authorized official is Denys Slesarenko .
The authorized official title is Ceo and has the following contact phone number (310) 659-7867.

The CLIA number assigned to this NPI record is 05D2222510 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/3/2019 and was last updated on 6/9/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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