Healthcare Provider Details

I. General information

NPI: 1598688541
Provider Name (Legal Business Name): SUSTAIN WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 VISTA WAY STE 315
OCEANSIDE CA
92054-6178
US

IV. Provider business mailing address

2424 VISTA WAY STE 315
OCEANSIDE CA
92054-6178
US

V. Phone/Fax

Practice location:
  • Phone: 646-338-0891
  • Fax:
Mailing address:
  • Phone: 646-338-0891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RASHIDA BLACK
Title or Position: OWNER
Credential: LCSW
Phone: 760-576-4160