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General NPI Number Information
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NPI Number | 1326566159
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Entity Type | Organization
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Legal Business Name | LIVE WELL LIFESTYLE LLC
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 08/31/2017
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Provider Practice Location Address
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Address Line | 321 N LARCHMONT BLVD STE 909
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City | LOS ANGELES
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State | CA
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Zip | 90004-6409
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Country | US
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Telephone | 310-923-1314
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Fax | 310-923-1314
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Provider Business Mailing Address
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Address Line | 1220 S LA JOLLA AVE
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City | LOS ANGELES
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State | CA
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Zip | 90035-2645
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Country | US
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Telephone | 310-923-1314
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHANDRA SCOFIELD
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Credential | L.A.C
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Telephone | 310-923-1314
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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 | 14897
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License Number State | CA
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