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General NPI Number Information
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NPI Number | 1477375707
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Entity Type | Organization
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Legal Business Name | NUWAVE WELLNESS
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 30700 RUSSELL RANCH RD STE 250
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91362-9507
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Country | US
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Telephone | 805-450-0171
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Fax |
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Provider Business Mailing Address
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Address Line | 30700 RUSSELL RANCH RD STE 250
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91362-9507
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Country | US
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Telephone | 805-450-0171
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HOLLY WHITMORE
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Credential |
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Telephone | 805-450-0171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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