Provider Demographics
NPI:1285008748
Name:INNDYDOZZER
Entity Type:Organization
Organization Name:INNDYDOZZER
Other - Org Name:QUANTUM DNA ACCELERATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENVENGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-358-2991
Mailing Address - Street 1:1112 MONTANA AVE
Mailing Address - Street 2:SUITE 243
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-1652
Mailing Address - Country:US
Mailing Address - Phone:310-358-2991
Mailing Address - Fax:
Practice Address - Street 1:1112 MONTANA AVE
Practice Address - Street 2:SUITE 243
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-1652
Practice Address - Country:US
Practice Address - Phone:310-358-2991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty