| NPI | 1376049049 |
|---|---|
| Doing Business As | LIFEWELLNESS INSTITUTE |
| Entity Type | Organization |
| Authorized Contact | DAVID M LARSON Physician 619-398-2960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A3360) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A122666) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CA 20A3360) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A122666) | |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2018-06-16 |