Provider Demographics
NPI:1194198390
Name:COMPREHENSIVE WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:COMPREHENSIVE WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-907-0783
Mailing Address - Street 1:751 N FAIR OAKS AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3069
Mailing Address - Country:US
Mailing Address - Phone:626-405-4001
Mailing Address - Fax:818-301-7443
Practice Address - Street 1:751 N FAIR OAKS AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-3069
Practice Address - Country:US
Practice Address - Phone:626-405-4001
Practice Address - Fax:818-301-7443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA666042084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty