Provider Demographics
NPI:1134090558
Name:SOULAIRE WELLNESS
Entity type:Organization
Organization Name:SOULAIRE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOULATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-473-3030
Mailing Address - Street 1:1934 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-4605
Mailing Address - Country:US
Mailing Address - Phone:310-473-3030
Mailing Address - Fax:310-473-4848
Practice Address - Street 1:1934 14TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4605
Practice Address - Country:US
Practice Address - Phone:310-473-3030
Practice Address - Fax:310-473-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain