| NPI | 1992413827 |
|---|---|
| Former Legal Business Name | DIVINE ELYSIAN WELLNESS |
| Entity Type | Organization |
| Authorized Contact | JOHN VILLASENOR Medical Director 424-267-6251 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2022-11-09 |
| Last Update Date | 2022-11-09 |