Provider Demographics
NPI:1891092235
Name:ENSPIRIT WELLNESS, INC
Entity Type:Organization
Organization Name:ENSPIRIT WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIALLO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:949-305-2820
Mailing Address - Street 1:20 FAIRBANKS STE 180
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618
Mailing Address - Country:US
Mailing Address - Phone:949-305-2820
Mailing Address - Fax:562-296-4944
Practice Address - Street 1:20 FAIRBANKS STE 180
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618
Practice Address - Country:US
Practice Address - Phone:949-305-2820
Practice Address - Fax:562-296-4944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13088171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty