Provider Demographics
NPI:1245748342
Name:THE ONE HEALTH BOUTIQUE, LLC
Entity Type:Organization
Organization Name:THE ONE HEALTH BOUTIQUE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-593-3804
Mailing Address - Street 1:5350 RILEY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2621
Mailing Address - Country:US
Mailing Address - Phone:858-888-6452
Mailing Address - Fax:619-793-1263
Practice Address - Street 1:5350 RILEY ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110
Practice Address - Country:US
Practice Address - Phone:858-888-6452
Practice Address - Fax:619-793-1263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-11
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty