Provider Demographics
NPI:1235782590
Name:CALIFORNIA CENTERS FOR PSYCHIATRIC WELLNESS AND HEALTH
Entity Type:Organization
Organization Name:CALIFORNIA CENTERS FOR PSYCHIATRIC WELLNESS AND HEALTH
Other - Org Name:WELLNESS AND HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PARMIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KHATIBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-351-0966
Mailing Address - Street 1:29911 NIGUEL RD UNIT 6305
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-2412
Mailing Address - Country:US
Mailing Address - Phone:800-351-0966
Mailing Address - Fax:800-674-7207
Practice Address - Street 1:160 N DATE ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3406
Practice Address - Country:US
Practice Address - Phone:800-674-2019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy