Healthcare Provider Details

I. General information

NPI: 1689358145
Provider Name (Legal Business Name): MEDIZEN HEATLH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 09/15/2024
Certification Date: 09/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 MIRA MESA BLVD STE B
SAN DIEGO CA
92121-4304
US

IV. Provider business mailing address

5955 MIRA MESA BLVD STE B
SAN DIEGO CA
92121-4304
US

V. Phone/Fax

Practice location:
  • Phone: 858-230-6384
  • Fax: 858-408-3654
Mailing address:
  • Phone: 858-230-6384
  • Fax: 858-408-3654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL DEWAYNE SCOTT
Title or Position: DIRECTOR
Credential: DC
Phone: 408-858-7438