Healthcare Provider Details

I. General information

NPI: 1053709378
Provider Name (Legal Business Name): DRAGONFLY NATURAL HEALTH, A NATUROPATHIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 W WASHINGTON BLVD STE 216
LOS ANGELES CA
90066-5100
US

IV. Provider business mailing address

8640 GULANA AVE UNIT J3001
PLAYA DEL REY CA
90293-7323
US

V. Phone/Fax

Practice location:
  • Phone: 323-929-7009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND-377
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM-259
License Number StateCA

VIII. Authorized Official

Name: DR. DEBORAH GLEISNER
Title or Position: OWNER
Credential: ND, LM, CPM
Phone: 206-300-8069