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General NPI Number Information
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NPI Number | 1417216821
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Entity Type | Organization
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Legal Business Name | EVOLUTION HOLISTIC HEALTHCARE, INCORPORATED
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Dates
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Enumeration Date | 05/07/2012
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 269 S BEVERLY DR STE 110
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-3851
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Country | US
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Telephone | 424-254-9622
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Fax |
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Provider Business Mailing Address
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Address Line | 269 S BEVERLY DR STE 110
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-3851
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Country | US
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Telephone | 424-254-9622
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. AARON BULLOCK
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Credential |
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Telephone | 424-254-9622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC10770
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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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 | 175L00000X
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Taxonomy Name | Homeopath
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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 | 33660
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 34748
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License Number State | CA
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