Healthcare Provider Details

I. General information

NPI: 1235294893
Provider Name (Legal Business Name): PREVENTIVE HEALTH ESSENTIALS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43875 WASHINGTON ST SUITE #C
PALM DESERT CA
92211-8249
US

IV. Provider business mailing address

1611 CRENSHAW BLVD SUITE 224
TORRANCE CA
90501-3123
US

V. Phone/Fax

Practice location:
  • Phone: 951-539-8984
  • Fax:
Mailing address:
  • Phone: 310-539-5722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number514131
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number514131
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number514131
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number95090658
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number11282
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code364SC2300X
TaxonomyChronic Care Clinical Nurse Specialist
License Number11282
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number514131
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11282
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number514131
License Number StateCA
# 10
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberG1112004
License Number StateCA

VIII. Authorized Official

Name: DR. MARTHA N MOZIA
Title or Position: CEO
Credential: DNP,GNP/FNP, PMH-BC
Phone: 31053955722