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General NPI Number Information
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NPI Number | 1053709378
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Entity Type | Organization
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Legal Business Name | DRAGONFLY NATURAL HEALTH, A NATUROPATHIC CORPORATION
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Dates
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Enumeration Date | 01/09/2015
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Last Update Date | 01/09/2015
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Provider Practice Location Address
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Address Line | 13101 W WASHINGTON BLVD STE 216
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City | LOS ANGELES
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State | CA
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Zip | 90066-5100
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Country | US
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Telephone | 323-929-7009
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Fax |
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Provider Business Mailing Address
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Address Line | 8640 GULANA AVE UNIT J3001
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7323
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEBORAH GLEISNER
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Credential | ND, LM, CPM
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Telephone | 206-300-8069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | LM-259
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | ND-377
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License Number State | CA
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