| Wellness Equity Alliance | |
|
969 E 12th St Ste D Los Angeles CA 90021-2201 | |
| (408) 341-9606 | |
| Not Available |
| Full Name | Wellness Equity Alliance |
|---|---|
| Speciality | Family Medicine |
| Location | 969 E 12th St Ste D, Los Angeles, California |
| Authorized Official Name and Position | Tyler Evans (CEO) |
| Authorized Official Contact | 4083419606 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellness Equity Alliance 250 Quail Ridge Rd Scotts Valley CA 95066-4821 Ph: () - | Wellness Equity Alliance 969 E 12th St Ste D Los Angeles CA 90021-2201 Ph: (408) 341-9606 |
| NPI Number | 1699471482 |
|---|---|
| Provider Enumeration Date | 02/02/2023 |
| Last Update Date | 08/13/2024 |
| Medicare PECOS PAC ID | 8527433085 |
|---|---|
| Medicare Enrollment ID | O20230414000654 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699471482 | NPI | - | NPPES |
| Provider Name | Tyler Evans |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912227125 PECOS PAC ID: 9335311059 Enrollment ID: I20170523002901 |
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