| Lucid Wellness Center | |
|
291 S La Cienega Blvd Ste 303 Beverly Hills CA 90211-3310 | |
| (424) 385-3110 | |
| Not Available |
| Full Name | Lucid Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 291 S La Cienega Blvd Ste 303, Beverly Hills, California |
| Authorized Official Name and Position | Eric Chaghouri (CEO) |
| Authorized Official Contact | 3108508657 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lucid Wellness Center 291 S La Cienega Blvd Ste 303 Beverly Hills CA 90211-3310 Ph: () - | Lucid Wellness Center 291 S La Cienega Blvd Ste 303 Beverly Hills CA 90211-3310 Ph: (424) 385-3110 |
| NPI Number | 1285395269 |
|---|---|
| Provider Enumeration Date | 01/03/2022 |
| Last Update Date | 02/25/2022 |
| Certification Date | 02/25/2022 |
| Medicare PECOS PAC ID | 8325403637 |
|---|---|
| Medicare Enrollment ID | O20230420000375 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285395269 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Thais Siewert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194348318 PECOS PAC ID: 6901222918 Enrollment ID: I20200820001080 |
| Provider Name | Clint Nacar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609466259 PECOS PAC ID: 1153738232 Enrollment ID: I20210408000601 |
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