Healthcare Provider Details

I. General information

NPI: 1265868053
Provider Name (Legal Business Name): MICHAEL WORLEY L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39755 DATE ST SUITE #207
MURRIETA CA
92563-2007
US

IV. Provider business mailing address

39755 DATE ST SUITE #207
MURRIETA CA
92563-2007
US

V. Phone/Fax

Practice location:
  • Phone: 951-698-7977
  • Fax: 951-698-1696
Mailing address:
  • Phone: 951-698-7977
  • Fax: 951-698-1696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number15639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: