| Createwellness | |
|
5250 Hayter Avenue Lakewood CA 90712 | |
| (805) 870-5709 | |
| Not Available |
| Full Name | Createwellness |
|---|---|
| Speciality | Social Worker |
| Location | 5250 Hayter Avenue, Lakewood, California |
| Authorized Official Name and Position | Kalkidan Zeryihun (CLINICAL DIRECTOR) |
| Authorized Official Contact | 8058705709 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Createwellness 10303 Dorchester St Bakersfield CA 93311-4921 Ph: (805) 870-5709 | Createwellness 5250 Hayter Avenue Lakewood CA 90712 Ph: (805) 870-5709 |
| NPI Number | 1689289944 |
|---|---|
| Provider Enumeration Date | 09/14/2020 |
| Last Update Date | 03/29/2021 |
| Certification Date | 03/29/2021 |
| Medicare PECOS PAC ID | 6507276763 |
|---|---|
| Medicare Enrollment ID | O20201029002398 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689289944 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kalkidan Zeryihun |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649651555 PECOS PAC ID: 5294145447 Enrollment ID: I20201029002054 |
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