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General NPI Number Information
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NPI Number | 1689540825
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Entity Type | Organization
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Legal Business Name | EVERGREEN GLOW NURSING WELLNESS SPA APC
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Dates
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Enumeration Date | 10/15/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 23133 VENTURA BLVD STE 103
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-1184
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Country | US
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Telephone | 747-265-9120
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Fax |
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Provider Business Mailing Address
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Address Line | 23133 VENTURA BLVD STE 103
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-1184
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Country | US
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Telephone | 747-265-9120
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Fax |
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Authorized Official
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Title or Position | CO-CEO
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Name | MS. DELPHINE B BEAUBRUN
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Credential | RN
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Telephone | 747-265-9120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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