Healthcare Provider Details

I. General information

NPI: 1558022004
Provider Name (Legal Business Name): PURE WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14600 SHERMAN WAY STE 300
VAN NUYS CA
91405-2272
US

IV. Provider business mailing address

5555 W 6TH ST # 2-105
LOS ANGELES CA
90036-3361
US

V. Phone/Fax

Practice location:
  • Phone: 818-781-7097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JODI-ANN FOSTER
Title or Position: PRESIDENT/ PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 213-713-3465