Provider Demographics
NPI:1316158520
Name:LIVE WELL - FAMILY MEDICINE CENTER OF NAPLES, INC.
Entity type:Organization
Organization Name:LIVE WELL - FAMILY MEDICINE CENTER OF NAPLES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-504-9053
Mailing Address - Street 1:PO BOX 828
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-0828
Mailing Address - Country:US
Mailing Address - Phone:562-434-7777
Mailing Address - Fax:
Practice Address - Street 1:4910 AIRPORT PLAZA DR STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1377
Practice Address - Country:US
Practice Address - Phone:562-434-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-28
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA063555261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care