MEDICARE: EVOLUTION HOLISTIC HEALTHCARE, 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	133N00000X	Nutritionist
2	171100000X	Acupuncturist	AC10770	CA
3	175F00000X	Naturopath
4	175L00000X	Homeopath
5	225700000X	Massage Therapist	33660	CA
6	2251X0800X	Orthopedic Physical Therapist	34748	CA

General Provider Information

NPI Number	:	1417216821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLUTION HOLISTIC HEALTHCARE, INCORPORATED

Provider Business Mailing Address
First Line	:	269 S BEVERLY DR
Second Line	:	STE 110
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3851
Country	:	US
Telephone Number	:	424-254-9622
Fax Number	:

Provider Business Practice Location Address
First Line	:	269 S BEVERLY DR
Second Line	:	STE 110
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3851
Country	:	US
Telephone Number	:	424-254-9622
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. AARON BULLOCK
Credential	:
Telephone Number	:	424-254-9622

Provider Enumeration Date	:	05/07/2012
Last Update Date	:	06/04/2013

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