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NPI Code Detail

MEDICARE: DANICA THORNBERRY L.AC.

MEDICARE:   DANICA  THORNBERRY  L.AC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171100000XAcupuncturistAC7797CA

General Provider Information

NPI Number : 1184947749
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANICA THORNBERRY L.AC.
Provider Business Mailing Address
First Line : 11980 SAN VICENTE BLVD STE 112
Second Line :
City : LOS ANGELES
State : CA
Zip : 90049-6602
Country : US
Telephone Number : 310-991-7797
Fax Number : 310-826-3713
Provider Business Practice Location Address
First Line : 11980 SAN VICENTE BLVD STE 112
Second Line :
City : LOS ANGELES
State : CA
Zip : 90049-6602
Country : US
Telephone Number : 310-991-7797
Fax Number : 310-826-3713
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2010
Last Update Date : 03/10/2010

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Directions to “ DANICA THORNBERRY L.AC.” Practice Location

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