Healthcare Provider Details

I. General information

NPI: 1750149357
Provider Name (Legal Business Name): NAUTICAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 N BROADWAY
SANTA ANA CA
92706-3908
US

IV. Provider business mailing address

151 KALMUS DR STE A203
COSTA MESA CA
92626-5999
US

V. Phone/Fax

Practice location:
  • Phone: 402-250-8989
  • Fax: 714-475-2746
Mailing address:
  • Phone: 714-330-7312
  • 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: MR. JAMES SEWELL
Title or Position: RCM
Credential:
Phone: 402-250-8989