MEDICARE: VANITY WELLNESS CENTER INCORPORATED

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1326787870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANITY WELLNESS CENTER INCORPORATED

Provider Business Mailing Address
First Line	:	19935 VENTURA BLVD FL 1
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-9605
Country	:	US
Telephone Number	:	818-454-5112
Fax Number	:

Provider Business Practice Location Address
First Line	:	5459 LUBAO AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2608
Country	:	US
Telephone Number	:	818-454-5112
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ARMEN AKOPYAN
Credential	:
Telephone Number	:	818-454-5112

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	06/02/2022

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