Healthcare Provider Details

I. General information

NPI: 1063217180
Provider Name (Legal Business Name): NATASHA USPENSKY HC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 EUCLID ST APT 1
SANTA MONICA CA
90404-1038
US

IV. Provider business mailing address

1235 EUCLID ST APT 1
SANTA MONICA CA
90404-1038
US

V. Phone/Fax

Practice location:
  • Phone: 612-910-1531
  • Fax:
Mailing address:
  • Phone: 612-910-1531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number72023108
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: