1679378293 NPI number — ELEVATE MIND AND WELLNESS, INC.

Table of content: (NPI 1679378293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679378293 NPI number — ELEVATE MIND AND WELLNESS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELEVATE MIND AND WELLNESS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679378293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9100 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
EAST TOWER SUITE 333 #1036
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-425-4558
Provider Business Mailing Address Fax Number:
651-666-1450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9100 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
EAST TOWER SUITE 333 #1036
Provider Business Practice Location Address City Name:
BEVERLY HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-425-4558
Provider Business Practice Location Address Fax Number:
651-666-1450
Provider Enumeration Date:
02/18/2025

Additional Information

Authorized Official

Authorized Official Last Name:
RASTGAR
Authorized Official First Name:
YASHA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-425-3558

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com