Healthcare Provider Details

I. General information

NPI: 1063265635
Provider Name (Legal Business Name): PAIN STRESS ANXIETY ACUPUNCTURE PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18351 BEACH BLVD STE B
HUNTINGTON BEACH CA
92648-1346
US

IV. Provider business mailing address

18351 BEACH BLVD STE B
HUNTINGTON BEACH CA
92648-1346
US

V. Phone/Fax

Practice location:
  • Phone: 714-913-3310
  • Fax:
Mailing address:
  • Phone: 714-913-3310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM A. SANDIFER
Title or Position: OWNER / CEO
Credential: L.AC
Phone: 818-426-1310