Healthcare Provider Details

I. General information

NPI: 1366078156
Provider Name (Legal Business Name): UNVEIL THE WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 TERRA NOVA BLVD
PACIFICA CA
94044-4308
US

IV. Provider business mailing address

1009 TERRA NOVA BLVD
PACIFICA CA
94044-4308
US

V. Phone/Fax

Practice location:
  • Phone: 916-502-4092
  • Fax:
Mailing address:
  • Phone: 916-502-4092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIKTORIYA NEVEROV-KRSTIC
Title or Position: DOCTOR
Credential: DAOM, LAC
Phone: 916-502-4092