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Organization
OCEANS EDGE WELLNESS INC
Active
Organization
OCEANS EDGE WELLNESS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHRISTINA MARIE REICHERT NURSE PRACTITIONER (EXECUTIVE DIRECTOR)
(310) 623-0502
Entity
Organization
Contact information
Practice address
1420 W 7TH ST, SAN PEDRO, CA 90732-3507
(310) 623-0502
Mailing address
1816 S ANCHOVY AVE, SAN PEDRO, CA 90732-4108
(310) 623-0502
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
NULL
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
NULL
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
2084P0802X
Addiction Psychiatry Physician
—
NULL
2084P0802X
Addiction Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
NULL
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
10/17/2024
Last updated
10/17/2024
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