Healthcare Provider Details

I. General information

NPI: 1164123444
Provider Name (Legal Business Name): OHANA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 UPPER RAGSDALE DR BLDG A
MONTEREY CA
93940-5736
US

IV. Provider business mailing address

2 UPPER RAGSDALE DR BLDG A
MONTEREY CA
93940-5736
US

V. Phone/Fax

Practice location:
  • Phone: 831-622-6970
  • Fax: 831-658-3058
Mailing address:
  • Phone: 831-622-6970
  • Fax: 831-658-3058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN SWICK
Title or Position: PRESIDENT
Credential: MD
Phone: 831-622-6970