Healthcare Provider Details

I. General information

NPI: 1801614540
Provider Name (Legal Business Name): OHANA INTEGRATIVE HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69550 HIGHWAY 111 STE 202
RANCHO MIRAGE CA
92270-2887
US

IV. Provider business mailing address

69550 HIGHWAY 111 STE 202
RANCHO MIRAGE CA
92270-2887
US

V. Phone/Fax

Practice location:
  • Phone: 760-902-4961
  • Fax:
Mailing address:
  • Phone: 760-902-4961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: PETER CHARLES SHORTS
Title or Position: CEO/OWNER
Credential: LCSW
Phone: 760-902-4961