=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831575448
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIENTRIST HEALING CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2015
-----------------------------------------------------
Last Update Date | 10/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2320 S ROBERTSON BLVD STE 101
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90034-2053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-876-1670
-----------------------------------------------------
Fax | 310-876-1469
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2320 S ROBERTSON BLVD STE 101
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90034-2053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-876-1670
-----------------------------------------------------
Fax | 310-876-1469
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | AFSHEEN NEHORAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-876-1670
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC15181
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC4308
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------