Healthcare Provider Details

I. General information

NPI: 1154145217
Provider Name (Legal Business Name): KYMA WELLNESS PSYCHOLOGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3423 MEDICI WAY UNIT 1
OCEANSIDE CA
92056-8737
US

IV. Provider business mailing address

3423 MEDICI WAY UNIT 1
OCEANSIDE CA
92056-8737
US

V. Phone/Fax

Practice location:
  • Phone: 707-548-2536
  • Fax:
Mailing address:
  • Phone: 707-548-2536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAINA CARTER
Title or Position: OWNER
Credential:
Phone: 707-548-2536