Provider Demographics
NPI:1780197160
Name:SALUSIVE, INC.
Entity type:Organization
Organization Name:SALUSIVE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WALEED
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-922-9562
Mailing Address - Street 1:5901 VALLEJO ST APT D
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2136
Mailing Address - Country:US
Mailing Address - Phone:949-922-9562
Mailing Address - Fax:
Practice Address - Street 1:5901 VALLEJO ST APT D
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2136
Practice Address - Country:US
Practice Address - Phone:949-922-9562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty