Divine Elysian Wellness

LBN: Divine Elysian Wellness
Divine Elysian Wellness is an health care organization with primary practice located at 28901 S Western Ave Ste 225 , Rancho Palos Verdes CA 90275-0824. The organization recently has only one registered license in Ambulatory Health Care Facilities / Health Service, which is considered as the primary health care specialty. Divine Elysian Wellness can be contacted via phone (310) 924-9241, or through Villasenor, John via phone (424) 267-6251.

Contact Information

Primary practice address
28901 S Western Ave Ste 225 Rancho Palos Verdes CA 90275-0824
Phone: (310) 924-9241
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Villasenor, John Doctor of Medicine (MD)
Phone: (424) 267-6251

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Health Service 261QH0100X

Profile Details

NPI number 1992413827
LBN Legal business name Divine Elysian Wellness
DBA Doing business as
Authorized official Villasenor, John Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Nov 9th, 2022
Last updated Nov 9th, 2022 - about 3 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992413827 NPPES
California Other 1568811271 NPI

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