Healthcare Provider Details

I. General information

NPI: 1265636617
Provider Name (Legal Business Name): TAMMY C VENTERS L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10180 CULVER BLVD
CULVER CITY CA
90232-3152
US

IV. Provider business mailing address

2025 4TH ST 302A
SANTA MONICA CA
90405-1122
US

V. Phone/Fax

Practice location:
  • Phone: 310-815-1454
  • Fax:
Mailing address:
  • Phone: 310-560-1753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 5367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: