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General NPI Number Information
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NPI Number | 1679209407
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Entity Type | Organization
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Legal Business Name | SPIRIT GATE WELLNESS
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 5259 W PICO BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90019-4043
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Country | US
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Telephone | 424-247-6468
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Fax |
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Provider Business Mailing Address
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Address Line | 1514 N BEVERLY DR
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-2314
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Country | US
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Telephone | 310-630-9836
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | TERESA THOMAS
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Credential |
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Telephone | 424-247-6468
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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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