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General NPI Number Information
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NPI Number | 1306368303
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Entity Type | Organization
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Legal Business Name | GOLDEN LIFE
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 12927 VENICE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90066-3509
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Country | US
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Telephone | 424-835-0395
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Fax |
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Provider Business Mailing Address
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Address Line | 14001 PALAWAN WAY APT 214
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6225
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Country | US
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Telephone | 424-835-0395
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST, OWNER
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Name | ASHLEY ELIZABETH ALDEN
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Credential | L.AC.
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Telephone | 424-835-0395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 17655
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License Number State | CA
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