Provider Demographics
NPI:1164074902
Name:NEW MOON WELLNESS INC.
Entity Type:Organization
Organization Name:NEW MOON WELLNESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MADRIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-579-2258
Mailing Address - Street 1:11054 VENTURA BLVD # 245
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3546
Mailing Address - Country:US
Mailing Address - Phone:818-579-2258
Mailing Address - Fax:
Practice Address - Street 1:16661 VENTURA BLVD STE 400
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1925
Practice Address - Country:US
Practice Address - Phone:818-579-2258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1669772166OtherMEDI-CAL