Healthcare Provider Details

I. General information

NPI: 1992176192
Provider Name (Legal Business Name): NATURAL LIFESTYLES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2138 W 109TH ST
LOS ANGELES CA
90047-4609
US

IV. Provider business mailing address

2138 W 109TH ST
LOS ANGELES CA
90047-4609
US

V. Phone/Fax

Practice location:
  • Phone: 323-743-7908
  • Fax:
Mailing address:
  • Phone: 323-743-7908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code332100000X
TaxonomyDepartment of Veterans Affairs (VA) Pharmacy
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. STACEY WEBB
Title or Position: CEO
Credential:
Phone: 32377437908