Provider Demographics
NPI:1417475179
Name:INTEGRATIVE LIFECARE
Entity Type:Organization
Organization Name:INTEGRATIVE LIFECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:KARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAROVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:323-609-3035
Mailing Address - Street 1:6200 PRIMROSE AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-3312
Mailing Address - Country:US
Mailing Address - Phone:310-779-2749
Mailing Address - Fax:
Practice Address - Street 1:12304 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2551
Practice Address - Country:US
Practice Address - Phone:323-609-3035
Practice Address - Fax:888-979-8761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17756171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty