Provider Demographics
NPI:1861757585
Name:WORKSITE WELLNESS LA
Entity type:Organization
Organization Name:WORKSITE WELLNESS LA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-758-9480
Mailing Address - Street 1:5955 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-1124
Mailing Address - Country:US
Mailing Address - Phone:323-758-9480
Mailing Address - Fax:323-758-8348
Practice Address - Street 1:5955 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-1124
Practice Address - Country:US
Practice Address - Phone:323-758-9480
Practice Address - Fax:323-758-8348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management