Healthcare Provider Details

I. General information

NPI: 1003770660
Provider Name (Legal Business Name): THE EMPOWER COLLECTIVE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9805 CAMPO RD STE 165 P.O BOX 65
SPRING VALLEY CA
91977-1471
US

IV. Provider business mailing address

9805 CAMPO RD STE 165
SPRING VALLEY CA
91977-1471
US

V. Phone/Fax

Practice location:
  • Phone: 619-889-8728
  • Fax:
Mailing address:
  • Phone: 619-889-8728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: ISABELLA F CAVELLA
Title or Position: DIRECTOR
Credential:
Phone: 619-889-8728