Provider Demographics
NPI:1821221284
Name:UPRISE L.L.C.
Entity Type:Organization
Organization Name:UPRISE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHEENA
Authorized Official - Middle Name:LISETTE
Authorized Official - Last Name:JONGENEEL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-449-1014
Mailing Address - Street 1:2811 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 540
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4803
Mailing Address - Country:US
Mailing Address - Phone:310-449-1014
Mailing Address - Fax:
Practice Address - Street 1:2811 WILSHIRE BLVD
Practice Address - Street 2:SUITE 540
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4803
Practice Address - Country:US
Practice Address - Phone:310-449-1014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12019171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty