MEDICARE: LIVE WELL LIFESTYLE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	14897	CA

General Provider Information

NPI Number	:	1326566159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVE WELL LIFESTYLE LLC

Provider Business Mailing Address
First Line	:	1220 S LA JOLLA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-2645
Country	:	US
Telephone Number	:	310-923-1314
Fax Number	:

Provider Business Practice Location Address
First Line	:	321 N LARCHMONT BLVD STE 909
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-6409
Country	:	US
Telephone Number	:	310-923-1314
Fax Number	:	310-923-1314

Authorized Official
Title or Position	:	OWNER
Name	:	CHANDRA SCOFIELD
Credential	:	L.A.C
Telephone Number	:	310-923-1314

Provider Enumeration Date	:	08/31/2017
Last Update Date	:	08/31/2017

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Directions to “LIVE WELL LIFESTYLE LLC ” Practice Location

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