Healthcare Provider Details

I. General information

NPI: 1861921066
Provider Name (Legal Business Name): MIGHTY RIVER WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 RIVERSIDE DR STE 1
STUDIO CITY CA
91602-1066
US

IV. Provider business mailing address

11650 RIVERSIDE DR. PH1
STUDIO CITY CA
91602
US

V. Phone/Fax

Practice location:
  • Phone: 818-760-4808
  • Fax:
Mailing address:
  • Phone: 818-760-4808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC16264
License Number StateCA

VIII. Authorized Official

Name: REBECCA HOEHN
Title or Position: OWNER
Credential: LAC
Phone: 818-760-4808