Healthcare Provider Details

I. General information

NPI: 1396519831
Provider Name (Legal Business Name): PROSPER WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S BARRINGTON AVE STE 112
LOS ANGELES CA
90025-5337
US

IV. Provider business mailing address

1079 MEADOWBROOK AVE APT 5
LOS ANGELES CA
90019-6716
US

V. Phone/Fax

Practice location:
  • Phone: 310-804-0009
  • Fax:
Mailing address:
  • Phone: 310-804-0009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MS. CLAUDIA BAETTIG
Title or Position: CEO
Credential: L.AC, DACM
Phone: 310-804-0009