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General NPI Number Information
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NPI Number | 1942021498
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Entity Type | Organization
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Legal Business Name | OCEANS EDGE WELLNESS INC
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 1420 W 7TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90732-3507
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Country | US
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Telephone | 310-623-0502
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Fax |
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Provider Business Mailing Address
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Address Line | 1816 S ANCHOVY AVE
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City | SAN PEDRO
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State | CA
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Zip | 90732-4108
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Country | US
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Telephone | 310-623-0502
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. CHRISTINA MARIE REICHERT
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Credential | NURSE PRACTITIONER
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Telephone | 310-623-0502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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