Provider Demographics
NPI:1760056477
Name:BECOMING WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:BECOMING WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:AMEZCUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-473-4409
Mailing Address - Street 1:2802 N PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-2257
Mailing Address - Country:US
Mailing Address - Phone:714-476-8828
Mailing Address - Fax:
Practice Address - Street 1:206 W 4TH ST STE 416
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4677
Practice Address - Country:US
Practice Address - Phone:714-406-3598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty