Healthcare Provider Details

I. General information

NPI: 1114236403
Provider Name (Legal Business Name): EMILY MONTES BARTLETT L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12114 VENICE BLVD. OASIS HEALING CENTER
LOS ANGELES CA
90066
US

IV. Provider business mailing address

19820 MONTAU DR
TOPANGA CA
90290-3324
US

V. Phone/Fax

Practice location:
  • Phone: 310-943-9044
  • Fax:
Mailing address:
  • Phone: 310-968-0675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: