# NOURISHING WELLNESS MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164466884
- **Authorized official:** DR. ALLEN HERMANN PETERS M.D. (PRESIDENT/MEDICAL DIRECTOR)
- **Authorized official phone:** (310) 373-7830

## Contact information

- **Practice address:** 819 N HARBOR DR STE 310, REDONDO BEACH, CA 90277-2056
- **Practice address phone:** (310) 373-7830
- **Practice address fax:** (310) 373-7830
- **Mailing address:** 819 N HARBOR DR STE 310, REDONDO BEACH, CA 90277-2056
- **Mailing address phone:** (310) 373-7830
- **Mailing address fax:** (310) 373-7840

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133VN1006X | Metabolic Nutrition Registered Dietitian | — | NULL | — |
| 133VN1006X | Metabolic Nutrition Registered Dietitian | — | — | — |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | NULL | Yes |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/15/2006
- **Last updated:** 04/20/2020