Provider Demographics
NPI:1871118661
Name:GILLI WELLNESS, INC.
Entity type:Organization
Organization Name:GILLI WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIILAT
Authorized Official - Middle Name:
Authorized Official - Last Name:STUPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-989-8508
Mailing Address - Street 1:1515 S GENESEE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3811
Mailing Address - Country:US
Mailing Address - Phone:310-989-8508
Mailing Address - Fax:
Practice Address - Street 1:1743 S LA CIENEGA BLVD STE X
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-4671
Practice Address - Country:US
Practice Address - Phone:310-989-8508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty