=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649905944
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEAK LIFE ACUPUNCTURE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2022
-----------------------------------------------------
Last Update Date | 07/20/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 E BROADWAY STE 202
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91205-2490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-823-6721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7260 APPERSON ST APT 108
-----------------------------------------------------
City | TUJUNGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91042-1871
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-823-6721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUNCTURE PHYSICIAN
-----------------------------------------------------
Name | BENITA SAFARYANS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-823-6721
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------