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
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
2084P0802X
Addiction Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
10/17/2024
Last updated
10/17/2024
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