Healthcare Provider Details

I. General information

NPI: 1235458902
Provider Name (Legal Business Name): NOEL C BUSBY L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7565 JALMIA WAY
LOS ANGELES CA
90046-1722
US

IV. Provider business mailing address

7565 JALMIA WAY
LOS ANGELES CA
90046-1722
US

V. Phone/Fax

Practice location:
  • Phone: 323-547-7721
  • Fax:
Mailing address:
  • Phone: 323-547-7721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number9604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: