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General NPI Number Information
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NPI Number | 1326532383
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Entity Type | Organization
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Legal Business Name | INNOVA WELLNESS INC
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Dates
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Enumeration Date | 06/21/2018
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 837 N GLENDALE AVE
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City | GLENDALE
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State | CA
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Zip | 91206-2128
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Country | US
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Telephone | 661-312-0788
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Fax |
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Provider Business Mailing Address
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Address Line | 837 N GLENDALE AVE
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City | GLENDALE
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State | CA
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Zip | 91206-2128
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Country | US
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Telephone | 661-312-0788
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS DANIELLE REDFERN
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Credential | L.AC
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Telephone | 661-312-0788
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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 | AC15970
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License Number State | CA
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