Healthcare Provider Details

I. General information

NPI: 1841144342
Provider Name (Legal Business Name): FOUNTAIN OF HEALTH MEDICAL AYURVEDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 BRUNSWICK RD STE 5
GRASS VALLEY CA
95945-9544
US

IV. Provider business mailing address

101 W MCKNIGHT WAY STE B
GRASS VALLEY CA
95949-9613
US

V. Phone/Fax

Practice location:
  • Phone: 530-464-8632
  • Fax:
Mailing address:
  • Phone: 530-464-8632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JESSICA LEE LUSIGNAN
Title or Position: OWNER
Credential: FNP-BC
Phone: 413-244-3964