Rise of the Phoenix Whole Health Center

Primary specialty

AcupuncturistTaxonomy code 171100000X

Legal business name

RISE OF THE PHOENIX WHOLE HEALTH CENTER

Practice address

1703 N Avalon Blvd
Wilmington, CA 90744-1432

Phone

(805) 405-1250

NPI assigned

Apr 9, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Diana Roman, L.AC

Title

Owner

Phone

(805) 405-1250

Specialties & licenses 1

Addresses

Other names 2

• Center Of Balanced Health Doing business as
• Highland Park Wellness Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586390400000",
    "number": "1831718022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 COOPER AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900421516",
            "telephone_number": "805-405-1250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 N AVALON BLVD",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "907441432",
            "telephone_number": "805-405-1250"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "810 Cooper Ave",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900421516",
            "country_code": "US",
            "telephone_number": "805-405-1250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RISE OF THE PHOENIX WHOLE HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-09",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A",
        "authorized_official_last_name": "ROMAN",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "805-405-1250",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "L.AC"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center Of Balanced Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Highland Park Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rufinita Ramoran
• Fernando Javier Ramos
• Christopher Charles Reardon, CADC, LADC II
• Jordan Riccoboni, MPA
• Richard M Peters OD an Optometric Corporation
• Roxana Rivera
• Mayra Guadalupe Rivero-Lopez
• Robert Jr Chiropractic Corporation
• Phillip Lee Rock, D.C.
• Evelyn Rodriguez Cervantes

• Acupuncturist in Wilmington, CA
• Providers in Wilmington, CA by specialty
• Acupuncturist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.