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General NPI Number Information
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NPI Number | 1962819789
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC WELLNESS CENTER INC
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 30300 AGOURA ROAD SUITE 195
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City | AGOURA HILLS
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State | CA
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Zip | 91301-5412
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Country | US
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Telephone | 818-532-7950
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Fax | 818-532-7685
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Provider Business Mailing Address
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Address Line | 30300 AGOURA ROAD SUITE 195
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City | AGOURA HILLS
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State | CA
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Zip | 91301-5412
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Country | US
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Telephone | 818-532-7950
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Fax | 818-532-7685
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Authorized Official
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Title or Position | OWNER
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Name | ELSA CALUMPIT CRUZ
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Credential | M.D
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Telephone | 818-795-2515
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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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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A75757
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License Number State | CA
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