Healthcare Provider Details

I. General information

NPI: 1306368303
Provider Name (Legal Business Name): GOLDEN LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12927 VENICE BLVD
LOS ANGELES CA
90066-3509
US

IV. Provider business mailing address

14001 PALAWAN WAY APT 214
MARINA DEL REY CA
90292-6225
US

V. Phone/Fax

Practice location:
  • Phone: 424-835-0395
  • Fax:
Mailing address:
  • Phone: 424-835-0395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17655
License Number StateCA

VIII. Authorized Official

Name: ASHLEY ELIZABETH ALDEN
Title or Position: ACUPUNCTURIST, OWNER
Credential: L.AC.
Phone: 424-835-0395