Healthcare Provider Details

I. General information

NPI: 1255413795
Provider Name (Legal Business Name): CENTER FOR HEALTH ENHANCEMENT AND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 ALMA REAL DR STE 211
PACIFIC PALISADES CA
90272-3748
US

IV. Provider business mailing address

881 ALMA REAL DR STE 211
PACIFIC PALISADES CA
90272-3748
US

V. Phone/Fax

Practice location:
  • Phone: 310-454-0060
  • Fax: 310-454-0065
Mailing address:
  • Phone: 310-454-0060
  • Fax: 310-454-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberPT8927
License Number StateCA

VIII. Authorized Official

Name: MR. DAVID V POWERS
Title or Position: OWNER
Credential: P.T.
Phone: 310-454-0060