Provider Demographics
NPI:1154911766
Name:HEART BASED HEALTH ACUPUNCTURE & WELLNESS
Entity type:Organization
Organization Name:HEART BASED HEALTH ACUPUNCTURE & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM , LAC
Authorized Official - Phone:818-815-9126
Mailing Address - Street 1:6711 FOREST LAWN DR STE 104
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1032
Mailing Address - Country:US
Mailing Address - Phone:818-815-9126
Mailing Address - Fax:
Practice Address - Street 1:6711 FOREST LAWN DR STE 104
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1032
Practice Address - Country:US
Practice Address - Phone:818-815-9126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1174174700Medicaid