Healthcare Provider Details

I. General information

NPI: 1720104284
Provider Name (Legal Business Name): ALEJANDRO VILLANUEVA L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6423 E PACIFIC COAST HWY
LONG BEACH CA
90803-4201
US

IV. Provider business mailing address

6423 E PACIFIC COAST HWY
LONG BEACH CA
90803-4201
US

V. Phone/Fax

Practice location:
  • Phone: 562-795-6680
  • Fax:
Mailing address:
  • Phone: 562-795-6680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number9481
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: