Healthcare Provider Details

I. General information

NPI: 1295449064
Provider Name (Legal Business Name): MONIMA WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3760 CONVOY ST STE 200
SAN DIEGO CA
92111-3743
US

IV. Provider business mailing address

PO BOX 675210
RANCHO SANTA FE CA
92067-5210
US

V. Phone/Fax

Practice location:
  • Phone: 858-922-4946
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MAX DOSHAY
Title or Position: CEO
Credential: PSYD
Phone: 858-922-4946