MEDICARE: RECOVERY WELLNESS 360

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	133N00000X	Nutritionist
2	207KA0200X	Allergy Physician
3	2083P0901X	Public Health & General Preventive Medicine Physician
4	261Q00000X	Clinic/Center
5	207RA0201X	Allergy & Immunology (Internal Medicine) Physician

General Provider Information

NPI Number	:	1811822471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY WELLNESS 360

Provider Business Mailing Address
First Line	:	1317 DEL NORTE RD STE 220B
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-8619
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1317 DEL NORTE RD STE 220B
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-8619
Country	:	US
Telephone Number	:	805-891-6551
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KEVIN TARDIFF
Credential	:
Telephone Number	:	805-891-6551

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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