# WELL PSYCHE MEDICAL GROUP

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

## Provider details

- **NPI number:** 1235476318
- **Authorized official:** ADEL MOSTAFAVI MD (CEO)
- **Authorized official phone:** (949) 400-2488

## Contact information

- **Practice address:** 15260 VENTURA BLVD STE 1200, SHERMAN OAKS, CA 91403-5347
- **Practice address phone:** (310) 871-0670
- **Practice address fax:** (310) 469-7845
- **Mailing address:** 15260 VENTURA BLVD STE 1200, SHERMAN OAKS, CA 91403-5347
- **Mailing address phone:** (310) 871-0670
- **Mailing address fax:** (310) 469-7845

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0800X | Psychiatry Physician | A92472 | CA | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | A92472 | CA | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | — |

## Other

- **Enumeration date:** 01/10/2013
- **Last updated:** 06/21/2024