=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427629898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEENA PARRY WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2021
-----------------------------------------------------
Last Update Date | 07/07/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5308 DERRY AVE STE K
-----------------------------------------------------
City | AGOURA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91301-4555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-309-8471
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6382 SMOKE TREE AVE
-----------------------------------------------------
City | OAK PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91377-1233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-309-8471
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUNCTURIST
-----------------------------------------------------
Name | DEENA PARRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-309-8471
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------