Healthcare Provider Details

I. General information

NPI: 1265780373
Provider Name (Legal Business Name): PURE ZEN WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 N COAST HIGHWAY 101 STE 1A
ENCINITAS CA
92024-1483
US

IV. Provider business mailing address

1114 N COAST HIGHWAY 101 STE 1A
ENCINITAS CA
92024-1483
US

V. Phone/Fax

Practice location:
  • Phone: 760-710-0234
  • Fax: 760-635-5727
Mailing address:
  • Phone: 760-710-0234
  • Fax: 760-635-5727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number14316
License Number StateCA

VIII. Authorized Official

Name: DR. ANNA KRASHENINNIKOVA
Title or Position: OWNER
Credential: L.AC.
Phone: 760-710-0234