Healthcare Provider Details

I. General information

NPI: 1962317677
Provider Name (Legal Business Name): 2ND WAVE INDUSTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 SIERRA CT STE 204
PALMDALE CA
93550-7615
US

IV. Provider business mailing address

1217 E PONDERA ST
LANCASTER CA
93535-3302
US

V. Phone/Fax

Practice location:
  • Phone: 661-916-7356
  • Fax:
Mailing address:
  • Phone: 661-916-7356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA KESTNER
Title or Position: CEO
Credential:
Phone: 661-916-7356