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General NPI Number Information
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NPI Number | 1831718022
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Entity Type | Organization
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Legal Business Name | RISE OF THE PHOENIX WHOLE HEALTH CENTER
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Dates
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Enumeration Date | 04/09/2020
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Last Update Date | 04/09/2020
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Provider Practice Location Address
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Address Line | 1703 N AVALON BLVD
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City | WILMINGTON
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State | CA
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Zip | 90744-1432
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Country | US
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Telephone | 805-405-1250
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Fax |
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Provider Business Mailing Address
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Address Line | 810 COOPER AVE
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City | LOS ANGELES
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State | CA
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Zip | 90042-1516
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Country | US
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Telephone | 805-405-1250
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DIANA ROMAN
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Credential | L.AC
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Telephone | 805-405-1250
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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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