Healthcare Provider Details

I. General information

NPI: 1891092235
Provider Name (Legal Business Name): ENSPIRIT WELLNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2011
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 FAIRBANKS STE 180
IRVINE CA
92618
US

IV. Provider business mailing address

20 FAIRBANKS STE 180
IRVINE CA
92618
US

V. Phone/Fax

Practice location:
  • Phone: 949-305-2820
  • Fax: 562-296-4944
Mailing address:
  • Phone: 949-305-2820
  • Fax: 562-296-4944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number13088
License Number StateCA

VIII. Authorized Official

Name: MS. ELENA FIALLO
Title or Position: PRESIDENT & CEO
Credential: L.AC.
Phone: 949-305-2820