Oceans Edge Wellness INC
Internal Medicine, Addiction Medicine in San Pedro, CA. Organization (NPI-2).
NPI number1942021498
StatusActive
Last updated in NPPESOct 17, 2024
Details
- NPI
- 1942021498
- Entity type
- Organization (NPI-2)
- Legal business name
- Oceans Edge Wellness INC
- Organization subpart
- No
- Enumeration date
- Oct 17, 2024
- Certification date
- Oct 17, 2024
- Last updated
- Oct 17, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207RA0401X | Internal Medicine, Addiction Medicine | – | – | Yes |
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | – | – | |
| 103TA0400X | Psychologist, Addiction (Substance Use Disorder) | – | – | |
| 2084P0802X | Psychiatry & Neurology, Addiction Psychiatry | – | – | |
| 2084P0804X | Psychiatry & Neurology, Child & Adolescent Psychiatry | – | – | |
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | – | – |
Practice location
1420 W 7th StSan Pedro, CA 90732-3507
Phone 310-623-0502
Mailing address
1816 S Anchovy AveSan Pedro, CA 90732-4108
Phone 310-623-0502
Other practice locations
1816 S Anchovy Ave
San Pedro, CA 90732-4108
San Pedro, CA 90732-4108
Phone 310-623-0502
1816 S Anchovy Ave
San Pedro, CA 90732-4108
San Pedro, CA 90732-4108
Phone 310-623-0502
Authorized official
Christina Marie Reichert
Executive Director
3106230502
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