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General NPI Number Information
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NPI Number | 1407492630
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Entity Type | Organization
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Legal Business Name | PURA ACUPUNCTURE & WELLNESS
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Dates
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Enumeration Date | 11/22/2019
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Last Update Date | 03/28/2022
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Provider Practice Location Address
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Address Line | 17203 VENTURA BLVD STE 2
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City | ENCINO
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State | CA
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Zip | 91316-4054
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Country | US
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Telephone | 310-513-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 17203 VENTURA BLVD STE 2
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City | ENCINO
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State | CA
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Zip | 91316-4054
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Country | US
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Telephone | 702-267-7155
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Fax |
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Authorized Official
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Title or Position | OWNER/ACUPUNCTURIST
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Name | NILA JALALI
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Credential | DACM, L.AC.
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Telephone | 310-513-5500
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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 |
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License Number State |
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