MEDICARE: NONNO WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1164233565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NONNO WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	2501 ARTESIA BLVD BLDG 203205
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-3273
Country	:	US
Telephone Number	:	310-666-5521
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 ARTESIA BLVD BLDG 203205
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-3273
Country	:	US
Telephone Number	:	310-807-1550
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JONATHON JOSEPH NEILY
Credential	:
Telephone Number	:	310-666-5521

Provider Enumeration Date	:	01/15/2025
Last Update Date	:	01/15/2025

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