MEDICARE: PREVENTIVE HEALTH ESSENTIALS INC

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	163WG0600X	Gerontology Registered Nurse	514131	CA
2	163WR0006X	Registered Nurse First Assistant	514131	CA
3	163WP0808X	Psychiatric/Mental Health Registered Nurse	514131	CA
4	171M00000X	Case Manager/Care Coordinator	95090658	CA
5	163WG0000X	General Practice Registered Nurse	11282	CA
6	364SC2300X	Chronic Care Clinical Nurse Specialist	11282	CA
7	101YM0800X	Mental Health Counselor	514131	CA
8	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11282	CA
9	163WC0400X	Case Management Registered Nurse	514131	CA
10	363LG0600X	Gerontology Nurse Practitioner	G1112004	CA

General Provider Information

NPI Number	:	1235294893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREVENTIVE HEALTH ESSENTIALS INC

Provider Business Mailing Address
First Line	:	1611 CRENSHAW BLVD
Second Line	:	SUITE 224
City	:	TORRANCE
State	:	CA
Zip	:	90501-3123
Country	:	US
Telephone Number	:	310-539-5722
Fax Number	:

Provider Business Practice Location Address
First Line	:	43875 WASHINGTON ST
Second Line	:	SUITE #C
City	:	PALM DESERT
State	:	CA
Zip	:	92211-8249
Country	:	US
Telephone Number	:	951-539-8984
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MARTHA N MOZIA
Credential	:	DNP,GNP/FNP, PMH-BC
Telephone Number	:	31053955722

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	12/19/2016

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