Healthcare Provider Details

I. General information

NPI: 1346903218
Provider Name (Legal Business Name): OPULENT HEALTH & WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 DECLARATION DR STE 4
CHICO CA
95973-4916
US

IV. Provider business mailing address

4267 MARINA CITY DR UNIT 1106
MARINA DEL REY CA
90292-5812
US

V. Phone/Fax

Practice location:
  • Phone: 424-384-3432
  • Fax: 833-619-0632
Mailing address:
  • Phone: 310-817-2012
  • Fax: 833-619-0632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BARBARA ALEENE BRUTON
Title or Position: CEO
Credential: MD
Phone: 310-817-2012