Healthcare Provider Details

I. General information

NPI: 1659914265
Provider Name (Legal Business Name): R3NEW WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2019
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 E DOMINGUEZ ST STE G
CARSON CA
90746-3547
US

IV. Provider business mailing address

1145 E DOMINGUEZ ST STE G
CARSON CA
90746-3547
US

V. Phone/Fax

Practice location:
  • Phone: 714-398-7655
  • Fax: 855-447-5526
Mailing address:
  • Phone:
  • Fax: 855-447-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: CRYSTA RICHTER
Title or Position: MEDICAL BILLER
Credential:
Phone: 424-903-5526