Healthcare Provider Details

I. General information

NPI: 1184530388
Provider Name (Legal Business Name): NEVARO WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20225 JUNE CT
RIVERSIDE CA
92508-2939
US

IV. Provider business mailing address

20225 JUNE CT
RIVERSIDE CA
92508-2939
US

V. Phone/Fax

Practice location:
  • Phone: 770-770-8774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MEYWA TANIHAHA
Title or Position: CEO
Credential:
Phone: 770-770-8774