Provider Demographics
NPI:1649141706
Name:WELLNESS OF MIND BODY AND SPIRIT LLC
Entity type:Organization
Organization Name:WELLNESS OF MIND BODY AND SPIRIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ELECTROLOGIST/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-571-8660
Mailing Address - Street 1:418 E LAS TUNAS DR UNIT 3G
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-5506
Mailing Address - Country:US
Mailing Address - Phone:626-571-8660
Mailing Address - Fax:844-270-2240
Practice Address - Street 1:842 E MISSION RD STE C
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-2761
Practice Address - Country:US
Practice Address - Phone:626-571-8660
Practice Address - Fax:844-270-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-13
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
No246ZS0400XSpecialist/Technologist, OtherSurgicalGroup - Multi-Specialty
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
No156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty