Provider Demographics
NPI:1891229282
Name:MAHAL EARTH WELLNESS CENTER
Entity Type:Organization
Organization Name:MAHAL EARTH WELLNESS CENTER
Other - Org Name:ROSEN MD TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-264-2969
Mailing Address - Street 1:1054 E GRAND AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2527
Mailing Address - Country:US
Mailing Address - Phone:805-904-6234
Mailing Address - Fax:805-904-6234
Practice Address - Street 1:1054 E GRAND AVE STE C
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2527
Practice Address - Country:US
Practice Address - Phone:805-904-6234
Practice Address - Fax:805-904-6234
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAHAL EARTH WELLNESS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23497261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain