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PISMO WELLNESS INC. A PROFESSIONAL MEDICAL CORPORATION NPI 1841765674


NPI Information

NPI: 1841765674
Provider Name: PISMO WELLNESS INC., A PROFESSIONAL MEDICAL CORPORATION
Classification: Clinic/Center - 261Q00000X
Entity Type: Organization

CLIA Number: 05D2163751

Address:
8500 WILSHIRE BLVD
SUITE 103
BEVERLY HILLS, CA
ZIP 90211
Phone: (424) 307-9504
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PISMO WELLNESS INC., A PROFESSIONAL MEDICAL CORPORATION is a clinic center in Beverly Hills, CA. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). PISMO WELLNESS INC., A PROFESSIONAL MEDICAL CORPORATION NPI is 1841765674. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

8500 WILSHIRE BLVD
SUITE 103
BEVERLY HILLS, CA
ZIP 90211
Phone: (424) 307-9504

The provider's authorized official is Jessie Martori .
The authorized official title is Manager and has the following contact phone number (602) 920-4290.

The CLIA number assigned to this NPI record is 05D2163751 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/8/2018 and was last updated on 2/14/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12084P0800XPsychiatry & NeurologyPsychiatryNo
2261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)No
3261Q00000XClinic/CenterYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.