Organization
PISMO WELLNESS INC., A PROFESSIONAL MEDICAL CORPORATION
Active
Organization
PISMO WELLNESS INC., A PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JESSIE MARTORI (MANAGER)
(602) 920-4290
Entity
Organization
Contact information
Practice address
8500 WILSHIRE BLVD, SUITE 103, BEVERLY HILLS, CA 90211
(424) 307-9504
Mailing address
8500 WILSHIRE BLVD, SUITE 103, BEVERLY HILLS, CA 90211
(424) 307-9504
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
10/08/2018
Last updated
02/14/2022
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