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General NPI Number Information
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NPI Number | 1568808368
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Entity Type | Organization
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Legal Business Name | TOTAL WELLNESS CLINIC INC
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 05/20/2013
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Provider Practice Location Address
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Address Line | 16661 VENTURA BLVD STE 108
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City | ENCINO
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State | CA
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Zip | 91436-1902
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Country | US
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Telephone | 818-239-9251
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Fax | 818-453-8539
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Provider Business Mailing Address
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Address Line | 16661 VENTURA BLVD STE 108
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City | ENCINO
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State | CA
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Zip | 91436-1902
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Country | US
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Telephone | 818-239-9251
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Fax | 818-453-8539
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | MISS MONA SOLEIMANI V
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Credential | LAC
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Telephone | 818-239-9251
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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 | AC8602
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License Number State | CA
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