Healthcare Provider Details

I. General information

NPI: 1730007493
Provider Name (Legal Business Name): BIENESTAR IS WELLBEING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 BEAUREGARD CRES
REDLANDS CA
92373-5601
US

IV. Provider business mailing address

621 BEAUREGARD CRES
REDLANDS CA
92373-5601
US

V. Phone/Fax

Practice location:
  • Phone: 917-349-4579
  • Fax:
Mailing address:
  • Phone: 917-349-4579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DAMIAN MAZZOTTA
Title or Position: CEO
Credential:
Phone: 917-439-4579