Provider Demographics
NPI:1235294893
Name:PREVENTIVE HEALTH ESSENTIALS INC
Entity Type:Organization
Organization Name:PREVENTIVE HEALTH ESSENTIALS INC
Other - Org Name:EASY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MOZIA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,GNP/FNP, PMH-BC
Authorized Official - Phone:3105-395-5722
Mailing Address - Street 1:1611 CRENSHAW BLVD
Mailing Address - Street 2:SUITE 224
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3123
Mailing Address - Country:US
Mailing Address - Phone:310-539-5722
Mailing Address - Fax:
Practice Address - Street 1:43875 WASHINGTON ST
Practice Address - Street 2:SUITE #C
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-8249
Practice Address - Country:US
Practice Address - Phone:951-539-8984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREVENTIVE HEALTH ESSENTIALS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-26
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA514131101YM0800X, 163WC0400X, 163WG0600X, 163WP0808X, 163WR0006X
CA11282163WG0000X, 363LP0808X, 364SC2300X
CA95090658171M00000X
CAG1112004363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty
No163WG0600XNursing Service ProvidersRegistered NurseGerontologyGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No364SC2300XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistChronic CareGroup - Single Specialty