Healthcare Provider Details

I. General information

NPI: 1356488357
Provider Name (Legal Business Name): TUTSIE NA SILAPALIKITPORN L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TUTSIE NA SILAPALIKITPORN L.AC.

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5315 N 41ST ST
PHOENIX AZ
85018-1605
US

IV. Provider business mailing address

PO BOX 32086
PHOENIX AZ
85064-2086
US

V. Phone/Fax

Practice location:
  • Phone: 602-954-4083
  • Fax:
Mailing address:
  • Phone: 602-954-4083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0139
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: