Well Medical, a Professional Corporation

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

WELL MEDICAL, A PROFESSIONAL CORPORATION

Practice address

929 Colorado Ave
Santa Monica, CA 90401-2716

Phone

(424) 221-5012

NPI assigned

May 31, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ildar Fazulyanov

Title

Chief Operating Officer

Phone

(310) 384-0970

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615161600000",
    "number": "1699123737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2280 SAWTELLE BLVD. # 101",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90064",
            "telephone_number": "310-384-0970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "929 COLORADO AVE",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904012716",
            "telephone_number": "424-221-5012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELL MEDICAL, A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-31",
        "last_updated": "2021-03-08",
        "certification_date": "2021-03-08",
        "status": "A",
        "authorized_official_last_name": "FAZULYANOV",
        "authorized_official_first_name": "ILDAR",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "310-384-0970"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zachary Noah Weitzner, MD
• Amanda Welby, LCSW
• Jennifer Jo Welch, OTR
• Mitchell Evan Welch, L.AC.
• Kristen Welke, LMFT
• Lindsay Katherine Wells
• Erica Leigh Wendel
• Daniel Jie Weng
• Leslie Elena Wenzell
• William Felix Werner Jr., DDS

• Nurse Practitioner in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.