Wellness Solution Medical Group Inc

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

WELLNESS SOLUTION MEDICAL GROUP INC

Practice address

6719 Greenbush Ave
Valley Glen, CA 91401-1204

Phone

(818) 487-1795

NPI assigned

Aug 13, 2019

Last updated

Sep 22, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brian Keith Gamble, M.D.

Title

President

Phone

(818) 487-1795

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1565654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632268800000",
    "number": "1710533948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12115 MAGNOLIA BLVD # 14",
            "city": "N HOLLYWOOD",
            "state": "CA",
            "postal_code": "916072609",
            "telephone_number": "818-487-1795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6719 GREENBUSH AVE",
            "city": "VALLEY GLEN",
            "state": "CA",
            "postal_code": "914011204",
            "telephone_number": "818-487-1795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS SOLUTION MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-13",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-22",
        "status": "A",
        "authorized_official_last_name": "GAMBLE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-487-1795",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA MEDICAL BOARD",
            "identifier": "A76121",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "notdo@bewell.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "no",
            "address_1": "6719 Greenbush Ave",
            "city": "Valley Glen",
            "state": "CA",
            "country_code": "US",
            "postal_code": "914011204",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Diagnostic Radiology Physician in Valley Glen, CA
• Providers in Valley Glen, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 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.