Provider Demographics
NPI:1689028557
Name:ENERGY LIFE SCIENCES INSTITUTE
Entity Type:Organization
Organization Name:ENERGY LIFE SCIENCES INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MILES
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DIPLAC
Authorized Official - Phone:310-231-3500
Mailing Address - Street 1:2001 S BARRINGTON AVE
Mailing Address - Street 2:SUITE# 116
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5363
Mailing Address - Country:US
Mailing Address - Phone:310-231-3500
Mailing Address - Fax:310-231-3570
Practice Address - Street 1:2001 S BARRINGTON AVE
Practice Address - Street 2:SUITE# 116
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5363
Practice Address - Country:US
Practice Address - Phone:310-231-3500
Practice Address - Fax:310-231-3570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7967171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty