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General NPI Number Information
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NPI Number | 1891488748
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Entity Type | Organization
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Legal Business Name | KOKUA WELLNESS INC.
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Dates
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Enumeration Date | 05/29/2023
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Last Update Date | 05/29/2023
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Provider Practice Location Address
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Address Line | 1219 VIA CIELITO
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City | VENTURA
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State | CA
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Zip | 93003-1225
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Country | US
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Telephone | 818-723-9403
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Fax |
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Provider Business Mailing Address
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Address Line | 2861 LOS ROBLES RD
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City | THOUSAND OAKS
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State | CA
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Zip | 91362-3359
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Country | US
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Telephone | 760-590-5135
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL BRADSHAW
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Credential | CATC I
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Telephone | 818-723-9403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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