Healthcare Provider Details

I. General information

NPI: 1033286638
Provider Name (Legal Business Name): ARLENE TUBIERA GILLO L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 12/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 FOREST LAWN DR SUITE 104
LOS ANGELES CA
90068-1046
US

IV. Provider business mailing address

6711 FOREST LAWN DR SUITE 104
LOS ANGELES CA
90068-1046
US

V. Phone/Fax

Practice location:
  • Phone: 323-851-7876
  • Fax: 323-851-7870
Mailing address:
  • Phone: 323-851-7876
  • Fax: 323-851-7870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: