Psychiatric Wellness Center Inc

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A75757 Issued in CA

Legal business name

PSYCHIATRIC WELLNESS CENTER INC

Practice address

30300 Agoura Road
Suite 195
Agoura Hills, CA 91301-5412

Phone

(818) 532-7950

Fax

(818) 532-7685

NPI assigned

Jul 14, 2014

Last updated

Jul 14, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elsa Calumpit Cruz, M.DNPI 1861524159

Title

Owner

Phone

(818) 795-2515

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Elsa Calumpit Cruz, M.D.

  • Psychiatry Physician
  • Pasadena, CA
  • NPI 1861524159
  Medicare reassignment NPD Authorized official
• Karmen N Fernandez Johnston

  • Marriage & Family Therapist
  • Agoura Hills, CA
  • NPI 1649923798
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405296000000",
    "number": "1962819789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30300 AGOURA ROAD",
            "address_2": "SUITE 195",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913015412",
            "telephone_number": "818-532-7950",
            "fax_number": "818-532-7685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30300 AGOURA ROAD",
            "address_2": "SUITE 195",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913015412",
            "telephone_number": "818-532-7950",
            "fax_number": "818-532-7685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHIATRIC WELLNESS CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-14",
        "last_updated": "2014-07-14",
        "status": "A",
        "authorized_official_last_name": "CRUZ",
        "authorized_official_first_name": "ELSA",
        "authorized_official_middle_name": "CALUMPIT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-795-2515",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A75757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Agoura Hills, CA
• Providers in Agoura Hills, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.