Healthcare Provider Details

I. General information

NPI: 1194198390
Provider Name (Legal Business Name): COMPREHENSIVE WELLNESS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 N FAIR OAKS AVE SUITE 301
PASADENA CA
91103-3069
US

IV. Provider business mailing address

751 N FAIR OAKS AVE SUITE 301
PASADENA CA
91103-3069
US

V. Phone/Fax

Practice location:
  • Phone: 626-405-4001
  • Fax: 818-301-7443
Mailing address:
  • Phone: 626-405-4001
  • Fax: 818-301-7443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberA66604
License Number StateCA

VIII. Authorized Official

Name: NICOLE ANN WOODS
Title or Position: CONTRACTING
Credential:
Phone: 909-907-0783