| Pismo Wellness Inc., A Professional Medical Corporation | |
|
8500 Wilshire Blvd Suite 103 Beverly Hills CA 90211 | |
| (424) 307-9504 | |
| Not Available |
| Full Name | Pismo Wellness Inc., A Professional Medical Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 8500 Wilshire Blvd, Beverly Hills, California |
| Authorized Official Name and Position | Jessie Martori (MANAGER) |
| Authorized Official Contact | 6029204290 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pismo Wellness Inc., A Professional Medical Corporation 8500 Wilshire Blvd Suite 103 Beverly Hills CA 90211 Ph: (424) 307-9504 | Pismo Wellness Inc., A Professional Medical Corporation 8500 Wilshire Blvd Suite 103 Beverly Hills CA 90211 Ph: (424) 307-9504 |
| NPI Number | 1841765674 |
|---|---|
| Provider Enumeration Date | 10/08/2018 |
| Last Update Date | 02/14/2022 |
| Certification Date | 02/14/2022 |
| Medicare PECOS PAC ID | 3274907134 |
|---|---|
| Medicare Enrollment ID | O20230428000080 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841765674 | NPI | - | NPPES |
| Provider Name | Zev Wiener |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497174023 PECOS PAC ID: 5294022521 Enrollment ID: I20160929001667 |
| Provider Name | Sean M Theus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245778620 PECOS PAC ID: 6204102825 Enrollment ID: I20180713002856 |
| Provider Name | Brittaney S Dennis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225319791 PECOS PAC ID: 0941620124 Enrollment ID: I20201009001868 |
| Provider Name | Jose Rosa Feliberti |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477948677 PECOS PAC ID: 2264841014 Enrollment ID: I20210506001282 |
| Provider Name | Theo Ogbonna Ikele |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871088518 PECOS PAC ID: 7113313123 Enrollment ID: I20220330003079 |
| Provider Name | Hayley Kincaid |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730814484 PECOS PAC ID: 4183093388 Enrollment ID: I20221209002505 |
| Provider Name | Catarina F Fleury |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366059669 PECOS PAC ID: 2769844075 Enrollment ID: I20230818001168 |
| Provider Name | Nancy Lynn Pletcher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932860673 PECOS PAC ID: 6204299746 Enrollment ID: I20230830003529 |
| Provider Name | Elizabeth Jennifer Puels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508599663 PECOS PAC ID: 3476901703 Enrollment ID: I20231128001492 |
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