Healthcare Provider Details

I. General information

NPI: 1760573554
Provider Name (Legal Business Name): ACTON ACUPUNCTURE & ALTERNATIVE HEALING CENTER, A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33315 SANTIAGO RD
ACTON CA
93510-1416
US

IV. Provider business mailing address

33315 SANTIAGO RD
ACTON CA
93510-1416
US

V. Phone/Fax

Practice location:
  • Phone: 661-269-2020
  • Fax: 661-269-2120
Mailing address:
  • Phone: 661-269-2020
  • Fax: 661-269-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 8473
License Number StateCA

VIII. Authorized Official

Name: CANDY JOHNSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 661-269-2020