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General NPI Number Information
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NPI Number | 1598476764
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Entity Type | Organization
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Legal Business Name | FIRST MENTAL WELLNESS
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Dates
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Enumeration Date | 12/08/2022
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 8242 SUNNYSEA DR
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7941
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Country | US
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Telephone | 970-216-0747
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Fax |
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Provider Business Mailing Address
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Address Line | 8549 WILSHIRE BLVD # 1113
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3104
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Country | US
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Telephone | 970-216-0747
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DONALD GENE RUBISH
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Credential | PHD
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Telephone | 970-216-0747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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