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General NPI Number Information
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NPI Number | 1194477026
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Entity Type | Organization
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Legal Business Name | LEAN AGING WELLNESS LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 01/21/2022
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Last Update Date | 02/22/2025
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Provider Practice Location Address
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Address Line | 2309 DALLIN ST
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City | LANCASTER
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State | CA
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Zip | 93536-5792
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Country | US
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Telephone | 661-524-6160
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Fax | 661-418-5916
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Provider Business Mailing Address
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Address Line | 2309 DALLIN ST
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City | LANCASTER
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State | CA
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Zip | 93536-5792
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Country | US
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Telephone | 661-753-7708
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Fax | 661-418-5916
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Authorized Official
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Title or Position | OWNER
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Name | MR. RON KUSEK JR.
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Credential | NSCA-CPT, CTNC, CMT
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Telephone | 661-753-7708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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