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General NPI Number Information
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NPI Number | 1891229282
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Entity Type | Organization
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Legal Business Name | MAHAL EARTH WELLNESS CENTER
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 04/12/2017
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Provider Practice Location Address
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Address Line | 1054 E GRAND AVE STE C
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-2527
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Country | US
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Telephone | 805-904-6234
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Fax | 805-904-6234
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Provider Business Mailing Address
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Address Line | 1054 E GRAND AVE STE C
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-2527
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Country | US
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Telephone | 805-904-6234
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Fax | 805-904-6234
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIA THERESA ROSEN
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Credential |
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Telephone | 805-264-2969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | A23497
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License Number State | CA
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