Healthcare Provider Details

I. General information

NPI: 1295790699
Provider Name (Legal Business Name): MARTIN L. HAINES III L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 E GREEN ST SUITE 106
PASADENA CA
91106-2413
US

IV. Provider business mailing address

1060 E GREEN ST SUITE 106
PASADENA CA
91106-2413
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-9987
  • Fax: 626-796-9914
Mailing address:
  • Phone: 626-796-9987
  • Fax: 626-796-9914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC8317
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: