Provider Demographics
NPI:1538354519
Name:STUDIO CITY WELLNESS CENTER
Entity type:Organization
Organization Name:STUDIO CITY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAW
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:818-761-1662
Mailing Address - Street 1:4789 VINELAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-3518
Mailing Address - Country:US
Mailing Address - Phone:818-761-1662
Mailing Address - Fax:818-761-0482
Practice Address - Street 1:4789 VINELAND AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-3518
Practice Address - Country:US
Practice Address - Phone:818-761-1662
Practice Address - Fax:818-761-0482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20667208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty