Healthcare Provider Details

I. General information

NPI: 1164717435
Provider Name (Legal Business Name): CIENEGA SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SOUTH LA CIENEGA BLVD
BEVERLY HILLS CA
90211
US

IV. Provider business mailing address

215 SOUTH LA CIENEGA BLD
BEVERLY HILLS CA
90211
US

V. Phone/Fax

Practice location:
  • Phone: 310-601-7509
  • Fax: 310-997-3539
Mailing address:
  • Phone: 310-601-7509
  • Fax: 310-997-3539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6481
License Number StateCA

VIII. Authorized Official

Name: ROSE NADALI
Title or Position: MANAGER
Credential:
Phone: 310-601-7509