Provider Demographics
NPI:1306368303
Name:GOLDEN LIFE
Entity Type:Organization
Organization Name:GOLDEN LIFE
Other - Org Name:GOLDEN LIFE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:424-835-0395
Mailing Address - Street 1:14001 PALAWAN WAY APT 214
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6225
Mailing Address - Country:US
Mailing Address - Phone:424-835-0395
Mailing Address - Fax:
Practice Address - Street 1:12927 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-3509
Practice Address - Country:US
Practice Address - Phone:424-835-0395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17655171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty