Provider Demographics
NPI:1730903816
Name:THRIVE HEALTH IV CLINIC PC
Entity type:Organization
Organization Name:THRIVE HEALTH IV CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-363-8757
Mailing Address - Street 1:9675 BRIGHTON WAY STE 410
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5192
Mailing Address - Country:US
Mailing Address - Phone:310-363-8757
Mailing Address - Fax:310-363-8758
Practice Address - Street 1:12750 NW 17TH ST UNIT 226
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33182-1423
Practice Address - Country:US
Practice Address - Phone:310-363-8757
Practice Address - Fax:310-363-8758
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THRIVE HEALTH IV CLINIC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-14
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty