Healthcare Provider Details

I. General information

NPI: 1770957268
Provider Name (Legal Business Name): POSITIVE ENERGY FOR LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 AUTO CENTER DR STE 108
FOOTHILL RANCH CA
92610-2848
US

IV. Provider business mailing address

800 W EL CAMINO REAL SUITE 180, ROOM 123
MOUNTAIN VIEW CA
94040-2586
US

V. Phone/Fax

Practice location:
  • Phone: 949-382-5886
  • Fax:
Mailing address:
  • Phone: 949-382-5886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number28718
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number7591
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number15662
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16035
License Number StateCA

VIII. Authorized Official

Name: JEFFREY ZHANG
Title or Position: MANAGER
Credential:
Phone: 949-382-5886